Healthcare Provider Details

I. General information

NPI: 1154721165
Provider Name (Legal Business Name): JAKE JUDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S 20TH AVE
SAFFORD AZ
85546-4052
US

IV. Provider business mailing address

1492 S 20TH AVE
SAFFORD AZ
85546-4052
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-2151
  • Fax:
Mailing address:
  • Phone: 928-348-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: