Provider Demographics
NPI:1528079993
Name:HUDSON, JEROME J (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:J
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:925 WESTBANK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-610-6919
Mailing Address - Fax:512-610-6927
Practice Address - Street 1:925 WESTBANK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-610-6919
Practice Address - Fax:512-610-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE2628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-0651861OtherTAX IDENTIFICATION NUMBER
TXE2628OtherSTATE MEDICAL LICENSE
TXH0032565OtherTX DPS
TXAH7900978OtherDEA
TXC17163Medicare UPIN