MEDICARE: DR. CHARLES P HUDSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	01029475A	IN
2	207NS0135X	Procedural Dermatology Physician	01029475A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00134400	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000079535	OTHER	IN	ANTHEM BCBS
3	1023595	OTHER	IN	CHAMPUS

General Provider Information

NPI Number	:	1356393102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES P HUDSON M.D.

Provider Business Mailing Address
First Line	:	3501 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0538
Country	:	US
Telephone Number	:	812-474-1234
Fax Number	:	812-402-3636

Provider Business Practice Location Address
First Line	:	3501 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0538
Country	:	US
Telephone Number	:	812-474-1234
Fax Number	:	812-402-3636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/27/2008

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Directions to “ DR. CHARLES P HUDSON M.D.” Practice Location

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