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General NPI Number Information
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NPI Number | 1952775751
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Entity Type | Organization
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Legal Business Name | MIDWEST UROGYNECOLOGY, LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2325 DOUGHERTY FERRY RD STE 206
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3356
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Country | US
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Telephone | 314-596-9955
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Fax | 314-596-9530
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Provider Business Mailing Address
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Address Line | 2325 DOUGHERTY FERRY RD STE 206
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3356
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Country | US
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Telephone | 314-596-9955
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Fax | 314-596-9530
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Authorized Official
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Title or Position | OWNER
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Name | JOHN JUDD
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Credential | MD
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Telephone | 314-596-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2011012595
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License Number State | MO
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