Provider Demographics
NPI:1982698023
Name:HUDSON, CASSELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CASSELL
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52834
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2834
Mailing Address - Country:US
Mailing Address - Phone:318-797-4169
Mailing Address - Fax:318-797-4169
Practice Address - Street 1:2855 LONG LAKE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-797-4169
Practice Address - Fax:318-797-4169
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD149R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1993085Medicaid
LA5DP32OtherGROUP PTAN : 5DP32
U50481Medicare UPIN
LA5U487Medicare ID - Type Unspecified
LA1993085Medicaid
LA5U487Medicare PIN