Healthcare Provider Details

I. General information

NPI: 1447230479
Provider Name (Legal Business Name): DONNA S JUDSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HIGHWAY 29 STE 306
CANTONMENT FL
32533-5808
US

IV. Provider business mailing address

PO BOX 533
CANTONMENT FL
32533-0533
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0559
  • Fax: 850-476-0599
Mailing address:
  • Phone: 850-476-0559
  • Fax: 850-476-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 73208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: