Provider Demographics
NPI:1104908615
Name:HUDSON, LORI B (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-795-0549
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:1871 W. ORANGE GROVE RD.
Practice Address - Street 2:STE. 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-498-5000
Practice Address - Fax:520-325-9087
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0025537207V00000X
AZ36170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ153830Medicaid
AZ153830Medicaid