MEDICARE: DR. BRUCE E HUDKINS MD

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	207Y00000X	Otolaryngology Physician	20122	OK

General Provider Information

NPI Number	:	1245229657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE E HUDKINS MD

Provider Business Mailing Address
First Line	:	6802 S OLYMPIA AVE STE 200
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1826
Country	:	US
Telephone Number	:	918-388-2398
Fax Number	:	918-388-2419

Provider Business Practice Location Address
First Line	:	6802 S OLYMPIA AVE WEST
Second Line	:	STE 200
City	:	TULSA
State	:	OK
Zip	:	74132
Country	:	US
Telephone Number	:	918-388-2398
Fax Number	:	918-388-2419

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	10/12/2017

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