Healthcare Provider Details

I. General information

NPI: 1386615672
Provider Name (Legal Business Name): STACEY ALLEN FINLEY HUDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 DOUBLE R BLVD
RENO NV
89521-8977
US

IV. Provider business mailing address

10735 DOUBLE R BLVD SUITE A12
RENO NV
89521-8977
US

V. Phone/Fax

Practice location:
  • Phone: 775-852-3624
  • Fax: 775-852-3672
Mailing address:
  • Phone: 775-852-3624
  • Fax: 775-852-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10393
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number10393
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: