Healthcare Provider Details

I. General information

NPI: 1679560551
Provider Name (Legal Business Name): JOHN R HUDGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E UNIVERSITY AVE STE 200
GEORGETOWN TX
78626-6821
US

IV. Provider business mailing address

205 E UNIVERSITY AVE STE 200
GEORGETOWN TX
78626-6821
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-1124
  • Fax: 512-868-9894
Mailing address:
  • Phone: 512-868-1124
  • Fax: 512-868-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4820779-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG8186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: