Basic Information
| Provider Information | |||||||||
| NPI: | 1487626008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUDSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 PARKCREST DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209944 | ||||||||
| Practice Location | |||||||||
| Address1: | 5508 PARKCREST DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | D0915 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 138111314 | 05 | TX | MEDICAID |