Healthcare Provider Details

I. General information

NPI: 1801085410
Provider Name (Legal Business Name): PATRICK HUDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 12/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE # 3
ALBUQUERQUE NM
87102-2706
US

IV. Provider business mailing address

733 STATE ROAD 344
EDGEWOOD NM
87015-6808
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-0070
  • Fax: 505-242-0060
Mailing address:
  • Phone: 505-280-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number76-199
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: