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NPI Code Detail

MEDICARE: CASSIDY L JUDA PA

MEDICARE: CASSIDY L JUDA PA
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
1363A00000XPhysician Assistant25943MT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M011003485OTHERMTMEDICARE PTAN

General Provider Information

NPI Number : 1245410042
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY L JUDA PA
Provider Business Mailing Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Provider Business Practice Location Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-587-4432
Fax Number : 406-587-7015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2007
Last Update Date : 07/08/2020

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Directions to “ CASSIDY L JUDA PA” Practice Location

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