Organization
WAYNE HUDSON DO INTEGRATED MEDICAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JAY BROOKE LCSW (OWNER/PARTNER)
(719) 691-2291
Entity
Organization
Contact information
Practice address
310 E OLIVE ST, LAMAR, CO 81052-2841
(719) 691-2291
Mailing address
310 E OLIVE ST, LAMAR, CO 81052-2841
(716) 931-9844
(719) 931-8007
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
07/12/2022
Last updated
12/07/2022
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