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NPI Code Detail

MEDICARE: JUDD H CHIDLOW MD

MEDICARE: JUDD H CHIDLOW MD
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
1207Y00000XOtolaryngology Physician010233LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154325058
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDD H CHIDLOW MD
Provider Business Mailing Address
First Line : 1455 E BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5634
Country : US
Telephone Number : 318-798-4569
Fax Number : 318-798-4423
Provider Business Practice Location Address
First Line : 1455 E BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5634
Country : US
Telephone Number : 318-798-4569
Fax Number : 318-798-4423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 07/08/2007

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Directions to “ JUDD H CHIDLOW MD” Practice Location

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