Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 52138 | SC |
NPI | 1306266390 |
---|---|
Provider Name | Ryan Thomas Hudson |
First Address | Spartanburg, SC 29303-3020 |
Second Address | Spartanburg, SC 29303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
521386 | (05) | SC |