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General NPI Number Information
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NPI Number | 1306064092
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Entity Type | Individual
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Provider Name | JACK RYAN HUDKINS MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 2820 E ROCK HAVEN ROAD SUITE 210
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City | HARRISONVILLE
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State | MO
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Zip | 64701
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Country | US
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Telephone | 816-380-2446
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Fax | 816-380-4791
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Provider Business Mailing Address
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Address Line | 2820 E ROCK HAVEN ROAD SUITE 210
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City | HARRISONVILLE
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State | MO
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Zip | 64701
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Country | US
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Telephone | 816-380-2446
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Fax | 816-380-4791
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6409
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License Number State | KS
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