Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME103869 | FL |
NPI | 1043417421 |
---|---|
Provider Name | Dr. Omar Dean Hudson |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 09/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000990300 | (05) | FL |
29192 | BCBS (01) | FL |
9796123 | AETNA (01) | FL |
CQ236Y | MEDICARE (01) | FL |