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General NPI Number Information
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NPI Number | 1801065545
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Entity Type | Organization
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Legal Business Name | MOLLY S JUDGE DPM
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 530 WASHINGTON STREET
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City | PORT CLINTON
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State | OH
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Zip | 43452-1935
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Country | US
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Telephone | 419-732-2618
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Fax | 419-732-1998
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Provider Business Mailing Address
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Address Line | 530 WASHINGTON STREET
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City | PORT CLINTON
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State | OH
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Zip | 43452-1935
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Country | US
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Telephone | 419-732-2618
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Fax | 419-732-1998
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOLLY S JUDGE
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Credential | DPM
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Telephone | 419-732-2618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2877
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License Number State | OH
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