MEDICARE: MR. VERNON BARRY HUDSON II CSFA

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1932536380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VERNON BARRY HUDSON II CSFA

Provider Business Mailing Address
First Line	:	10614 LITTLE BEND LN
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-2319
Country	:	US
Telephone Number	:	813-220-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	10614 LITTLE BEND LN
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-2319
Country	:	US
Telephone Number	:	813-220-1624
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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