Healthcare Provider Details

I. General information

NPI: 1447301072
Provider Name (Legal Business Name): BENJAMIN HUDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-4361
US

IV. Provider business mailing address

1600 BROAD AVE
GULFPORT MS
39501-3603
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-1111
  • Fax:
Mailing address:
  • Phone: 228-863-1132
  • Fax: 228-865-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberXH8195364
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMS17996
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: