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Individual

HENRY L HUDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5565 GROSSMONT CENTER DR., BLDG3 STE 551, LA MESA, CA 91942-9194
(800) 898-2020
(844) 897-3788
Mailing address
5565 GROSSMONT CENTER DR STE 551, LA MESA, CA 91942-3078
(800) 898-2020
(505) 344-5404

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
24189
AZ
207W00000X
Ophthalmology Physician
Primary
G76091
CA
207W00000X
Ophthalmology Physician
MD2014-0974
NM
207WX0107X
Retina Specialist (Ophthalmology) Physician
MD2014-0974
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2629305001
CIGNA
AZ
01
343955
AHCCCS
AZ
05
55109039
NM
01
629190
AETNA
AZ
01
AZ0392720
BLUE CROSS/ BLUE SHIELD
AZ
Enumeration date
05/05/2006
Last updated
07/21/2022
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