Healthcare Provider Details

I. General information

NPI: 1164516845
Provider Name (Legal Business Name): TIMOTHY HOWARD HUDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18132 PIONEER CT
LAKE OSWEGO OR
97034-7240
US

IV. Provider business mailing address

9205 SW BARNES RD WEST PAVILLION, 2ND FLOOR
PORTLAND OR
97225-6603
US

V. Phone/Fax

Practice location:
  • Phone: 503-201-2886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00036558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: