MEDICARE: MRS. JUDITH M EGERTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F6601	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F6601	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1083748677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH M EGERTON M.D.

Provider Business Mailing Address
First Line	:	4209 HOUSE OF YORK
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-3455
Country	:	US
Telephone Number	:	512-372-8933
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N SAM HOUSTON PKWY E
Second Line	:	SUITE 245
City	:	HOUSTON
State	:	TX
Zip	:	77060-4021
Country	:	US
Telephone Number	:	877-293-1573
Fax Number	:	877-356-3108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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