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NPI Code Detail

MEDICARE: JUDD CHARLES ALLEN MD

MEDICARE: JUDD CHARLES ALLEN 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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician10585249-1205UT
2207X00000XOrthopaedic Surgery Physician10585249-1205UT

General Provider Information

NPI Number : 1639463714
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDD CHARLES ALLEN MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-492-2663
Fax Number :
Provider Business Practice Location Address
First Line : 354 W CROSSROADS BLVD
Second Line :
City : SARATOGA SPRINGS
State : UT
Zip : 84045-5506
Country : US
Telephone Number : 801-341-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2011
Last Update Date : 03/12/2026

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