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Individual

SAMUEL DAVID HUDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
137 STATE ROUTE 3117, SOUTH SHORE, KY 41175-9597
(606) 932-2079
(606) 932-2313
Mailing address
137 STATE ROUTE 3117, SOUTH SHORE, KY 41175-9597
(606) 932-2079
(606) 932-2313

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
56722
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0492219
OHIO MEDICAID
OH
05
7100681350
KY
Enumeration date
04/22/2019
Last updated
06/22/2022
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