MEDICARE: MS. JUDITH A INGALLS IV 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
1	207Q00000X	Family Medicine Physician	23364	AZ

General Provider Information

NPI Number	:	1811962590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH A INGALLS IV MD

Provider Business Mailing Address
First Line	:	PO BOX 2892
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-2892
Country	:	US
Telephone Number	:	480-488-0575
Fax Number	:	480-374-5253

Provider Business Practice Location Address
First Line	:	36800 N SIDEWINDER
Second Line	:	SUTIE A4
City	:	CAREFREE
State	:	AZ
Zip	:	85377-5848
Country	:	US
Telephone Number	:	480-595-0431
Fax Number	:	480-595-2322

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	01/14/2022

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