Individual
DR. BONNIE B. HUDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3788
(904) 390-3429
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME69794
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
ME69794
FL
2080P0214X
Pediatric Pulmonology Physician
Primary
ME69794
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000693514A
—
GA
05
—
379239100
—
FL
Enumeration date
08/22/2006
Last updated
10/18/2011
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