Healthcare Provider Details

I. General information

NPI: 1700830833
Provider Name (Legal Business Name): ROGER J HUDGINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 101
ORLANDO FL
32803-1435
US

IV. Provider business mailing address

615 E PRINCETON ST STE 101
ORLANDO FL
32803-1435
US

V. Phone/Fax

Practice location:
  • Phone: 407-236-0006
  • Fax: 407-236-0007
Mailing address:
  • Phone: 407-236-0006
  • Fax: 407-236-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME138199
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.094337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: