Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25785 | OK |
Y | 207XS0106X | Orthopaedic Hand Surgeon | M-12123 | ID |
NPI | 1013113323 |
---|---|
Provider Name | Dustin I Judd |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83702-4565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2007 |
Last Update Date | 20/03/2017 |