MEDICARE: DR. JOHN LAWRENCE 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	207Q00000X	Family Medicine Physician	19771	CO

General Provider Information

NPI Number	:	1376756718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LAWRENCE HUDSON M.D.

Provider Business Mailing Address
First Line	:	1044 S 88TH ST STE 2
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9417
Country	:	US
Telephone Number	:	303-666-7119
Fax Number	:	303-666-0220

Provider Business Practice Location Address
First Line	:	1044 S 88TH ST STE 2
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9417
Country	:	US
Telephone Number	:	303-666-7119
Fax Number	:	303-666-0220

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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