Provider Demographics
NPI:1669919619
Name:HUDSON, DWAYNE
Entity type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 SOMERSET DR APT 401
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2785
Mailing Address - Country:US
Mailing Address - Phone:516-643-8402
Mailing Address - Fax:
Practice Address - Street 1:2740 SOMERSET DR APT 401
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-2785
Practice Address - Country:US
Practice Address - Phone:516-643-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other