Provider Demographics
NPI:1366428211
Name:HUDSON, PAUL BRYAN (MDPHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRYAN
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7566 N LA CHOLLA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:520-742-4139
Mailing Address - Fax:520-742-9618
Practice Address - Street 1:7566 N LA CHOLLA BLVD
Practice Address - Street 2:STE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-742-4139
Practice Address - Fax:520-742-9618
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ699994OtherAETNA
AZAZ0258200OtherBLUE CROSS BLUE SHIELD AZ
AZ1Z0217OtherHEALTHNET
AZ277089Medicaid
AZ699994OtherAETNA
AZAZ0258200OtherBLUE CROSS BLUE SHIELD AZ