Provider Demographics
NPI:1780097121
Name:HUDSON, JERRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:JERRYCE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4016
Mailing Address - Country:US
Mailing Address - Phone:281-485-0334
Mailing Address - Fax:281-485-3308
Practice Address - Street 1:4320 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4016
Practice Address - Country:US
Practice Address - Phone:281-485-0334
Practice Address - Fax:281-485-3308
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine