Healthcare Provider Details

I. General information

NPI: 1477552289
Provider Name (Legal Business Name): PATRICK H JUDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 10TH CT STE 200B
VERO BEACH FL
32960-5013
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-226-4810
  • Fax: 772-226-4825
Mailing address:
  • Phone: 772-567-4311
  • Fax: 772-794-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD437414
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number16369
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME122879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: