Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00888 | MD |
NPI | 1144205808 |
---|---|
Provider Name | Dr. Eugene O Hudyma |
First Address | Glen Burnie, MD 21061-4298 |
Second Address | Glen Burnie, MD 21061-4298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379248000 | (05) | MD |
480034105 | PALMETTO GBA MEDICARE RR (01) | MD |
T59878 | (02) |