Provider Demographics
NPI:1962590760
Name:HUDSON, ALLISON CASEY (DO)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:CASEY
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CASEY
Other - Last Name:FRAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:307 BOATNER ROAD
Mailing Address - Street 2:
Mailing Address - City:EGLIN, AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542
Mailing Address - Country:US
Mailing Address - Phone:850-883-8979
Mailing Address - Fax:850-883-9792
Practice Address - Street 1:307 BOATNER ROAD
Practice Address - Street 2:
Practice Address - City:EGLIN, AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-8979
Practice Address - Fax:850-883-9792
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1672208M00000X
GA102619208M00000X
OHOHIO TRAINING CERT.207R00000X
IN02003357A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN