MEDICARE: JUDITH RICHARDSON LUBBERS 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	207Q00000X	Family Medicine Physician	35054890L	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00252404	OTHER		MEDICARE RR HOCKING

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000367000	OTHER	OH	BCBS
4	000000315927	OTHER		HOCKING BCBS

General Provider Information

NPI Number	:	1639128440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH RICHARDSON LUBBERS M.D.

Provider Business Mailing Address
First Line	:	22498 CLAY LICK RD
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-9749
Country	:	US
Telephone Number	:	740-380-9241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 DUBLIN RD STE 400
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1081
Country	:	US
Telephone Number	:	740-380-8344
Fax Number	:

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	12/05/2016

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