Healthcare Provider Details

I. General information

NPI: 1285643213
Provider Name (Legal Business Name): MARCUS W. HUDOCK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GALAXY WAY STE 400
CONCORD CA
94520-5725
US

IV. Provider business mailing address

1001 GALAXY WAY STE 400
CONCORD CA
94520-5725
US

V. Phone/Fax

Practice location:
  • Phone: 925-225-5837
  • Fax: 925-225-5838
Mailing address:
  • Phone: 925-225-5837
  • Fax: 925-225-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberPA15978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: