Healthcare Provider Details

I. General information

NPI: 1700947561
Provider Name (Legal Business Name): JOHN WILBER HUDSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93638-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5457
  • Fax: 559-353-5424
Mailing address:
  • Phone: 559-353-5457
  • Fax: 559-353-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 13368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: