Healthcare Provider Details

I. General information

NPI: 1780846592
Provider Name (Legal Business Name): JOSHUA M JUDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST C224
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE STREET C224
LEXINGTON KY
40536
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6346
  • Fax:
Mailing address:
  • Phone: 859-323-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberTP323
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: