Provider Demographics
NPI:1801085410
Name:HUDSON, PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 STATE ROAD 344
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-6808
Mailing Address - Country:US
Mailing Address - Phone:505-280-4284
Mailing Address - Fax:
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE # 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-242-0070
Practice Address - Fax:505-242-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-199208200000X
174V00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174V00000XOther Service ProvidersClinical Ethicist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health