Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 15507 | MS |
NPI | 1013930122 |
---|---|
Provider Name | Clay B Hudson |
First Address | Tupelo, MS 38801-6309 |
Second Address | Tupelo, MS 38801-6309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122670 | (05) | MS |
H23467 | (02) | MS |