MEDICARE: DR. MARC WARREN JUDD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A66629	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A66629	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1124025218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC WARREN JUDD M.D.

Provider Business Mailing Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 190
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-531-9400
Fax Number	:	805-531-9499

Provider Business Practice Location Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 190
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-531-9400
Fax Number	:	805-531-9499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/12/2012

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