Individual
DR. GARY W HUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
1105 EAGLETREE LN SE, HUNTSVILLE, AL 35801-6447
(256) 882-7873
(256) 882-7874
Mailing address
1105 EAGLETREE LN SE, HUNTSVILLE, AL 35801-6447
(256) 882-7873
(256) 882-7874
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3677
AL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12133
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008606360
—
AL
01
—
51000927
BLUE CROSS BLUE SHIELD AL
AL
01
—
720892
UNITED CONCORDIA
AL
01
—
760775732
PRINCIPAL
AL
Enumeration date
04/14/2006
Last updated
10/12/2009
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