Individual
DR. OMAR DEAN HUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1223 GATEWAY DR STE 1G, MELBOURNE, FL 32901-2607
(321) 723-0072
(321) 952-0850
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 723-0072
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME103869
FL
2080P0205X
Pediatric Endocrinology Physician
Primary
ME103869
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000990300
—
FL
01
—
29192
BCBS
FL
01
—
9796123
AETNA
FL
01
—
CQ236Y
MEDICARE
FL
Enumeration date
06/29/2007
Last updated
02/13/2023
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