Organization
DERMATOLGY & DERMATOLOGIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY DAVID HUDSON MD (DERMATOLOGIST PRESIDENT)
(423) 928-9014
Entity
Organization
Contact information
Practice address
1021 W OAKLAND DR, SUITE 102, JOHNSON CITY, TN 37604-0000
(423) 928-9014
(423) 928-3559
Mailing address
1021 W OAKLAND AVE, SUITE 102, JOHNSON CITY, TN 37604-2191
(423) 928-9014
(423) 928-3559
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD0000013019
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036521
BCBS
TN
05
—
3701830
—
TN
01
—
TN0101
JOHN DEERE
TN
Enumeration date
11/08/2006
Last updated
08/22/2020
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