MEDICARE: DR. SAMUEL LAWRENCE JUDICE 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	2084P0800X	Psychiatry Physician	G83028	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	G83028	CA

General Provider Information

NPI Number	:	1518295385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LAWRENCE JUDICE M.D.

Provider Business Mailing Address
First Line	:	341 SPRUCE ST
Second Line	:	SUITE E
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1894
Country	:	US
Telephone Number	:	415-859-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 SPRUCE ST
Second Line	:	SUITE E
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1894
Country	:	US
Telephone Number	:	415-859-5900
Fax Number	:

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

Provider Enumeration Date	:	12/06/2009
Last Update Date	:	12/06/2009

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