Organization
HUDSON FAMILY PRACTICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY JOHN WAGNER D.O. (PRESIDENT)
(330) 344-3000
Entity
Organization
Contact information
Practice address
5655 HUDSON DR, SUITE 303, HUDSON, OH 44236
(330) 800-4800
(330) 653-3007
Mailing address
5655 HUDSON DR, SUITE 303, HUDSON, OH 44236
(330) 800-4800
(330) 653-3007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2152790
—
OH
01
—
CG0422
RAILROAD MEDICARE
OH
Enumeration date
02/12/2007
Last updated
01/26/2021
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