MEDICARE: DR. PAUL BRYAN HUDSON M.D..PH.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	207RG0100X	Gastroenterology Physician	15600	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	699994	OTHER	AZ	AETNA
2	AZ0258200	OTHER	AZ	BLUE CROSS BLUE SHIELD AZ
3	1Z0217	OTHER	AZ	HEALTHNET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366428211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BRYAN HUDSON M.D..PH.D.

Provider Business Mailing Address
First Line	:	7566 N LA CHOLLA BLVD
Second Line	:	STE A
City	:	TUCSON
State	:	AZ
Zip	:	85741-2307
Country	:	US
Telephone Number	:	520-742-4139
Fax Number	:	520-742-9618

Provider Business Practice Location Address
First Line	:	7566 N LA CHOLLA BLVD
Second Line	:	STE A
City	:	TUCSON
State	:	AZ
Zip	:	85741-2307
Country	:	US
Telephone Number	:	520-742-4139
Fax Number	:	520-742-9618

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/09/2007

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