MEDICARE: JAMES MELVIN HUDSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	036058812	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00069175	OTHER	IL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013994144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MELVIN HUDSON M.D.

Provider Business Mailing Address
First Line	:	1310 DADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1685
Country	:	US
Telephone Number	:	618-433-5005
Fax Number	:	618-467-1053

Provider Business Practice Location Address
First Line	:	1310 DADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1685
Country	:	US
Telephone Number	:	618-433-5005
Fax Number	:	618-467-1053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/04/2010

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