Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME69794 | FL |
N | 2080N0001X | Neonatal-Perinatal Doctor | ME69794 | FL |
Y | 2080P0214X | Pediatric Pulmonologist | ME69794 | FL |
NPI | 1457467375 |
---|---|
Provider Name | Dr. Bonnie B. Hudak |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000693514A | (05) | GA |
379239100 | (05) | FL |
B70734 | (02) |