Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD198974 | OR |
NPI | 1063822583 |
---|---|
Provider Name | Dr. Justin D Hudson |
First Address | Eugene, OR 97440-1648 |
Second Address | Eugene, OR 97401-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 15/09/2020 |