Healthcare Provider Details

I. General information

NPI: 1972886497
Provider Name (Legal Business Name): JENNIFER HUDMAN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOUTHEAST PKWY
AZLE TX
76020-3453
US

IV. Provider business mailing address

604 SOUTHEAST PKWY
AZLE TX
76020-3453
US

V. Phone/Fax

Practice location:
  • Phone: 817-270-2320
  • Fax: 817-270-2450
Mailing address:
  • Phone: 817-270-2320
  • Fax: 817-270-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM0759
License Number StateTX

VIII. Authorized Official

Name: JENNIFER HUDMAN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 817-270-2320