Individual
DR. MARK LAWRENCE HUDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, UFJP NEONATOLOGY DEPT, JACKSONVILLE, FL 32209-6511
(904) 244-3508
(904) 244-3028
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME75147
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME75147
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000761758A
—
GA
05
—
3790495-00
—
FL
Enumeration date
03/12/2006
Last updated
10/06/2008
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