Provider Demographics
NPI:1033203419
Name:LUI, JUDY H (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:H
Last Name:LUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-1689
Mailing Address - Country:US
Mailing Address - Phone:505-286-1900
Mailing Address - Fax:505-281-5157
Practice Address - Street 1:1950-C OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-286-1900
Practice Address - Fax:505-281-5157
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-286208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000F3658Medicaid
NM000F3658Medicaid
G09990Medicare UPIN