Healthcare Provider Details

I. General information

NPI: 1801058003
Provider Name (Legal Business Name): JUDD MORGAN WHITTAKER R.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W THUNDERBIRD RD APT 24-12
PHOENIX AZ
85023-6020
US

IV. Provider business mailing address

2140 W THUNDERBIRD RD APT 24-12
PHOENIX AZ
85023-6020
US

V. Phone/Fax

Practice location:
  • Phone: 602-696-2472
  • Fax:
Mailing address:
  • Phone: 602-696-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number008524
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: