Provider Demographics
NPI:1083748677
Name:EGERTON, JUDITH M (MD)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:EGERTON
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 1:4209 HOUSE OF YORK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-3455
Mailing Address - Country:US
Mailing Address - Phone:512-372-8933
Mailing Address - Fax:
Practice Address - Street 1:507 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4021
Practice Address - Country:US
Practice Address - Phone:877-293-1573
Practice Address - Fax:877-356-3108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF6601OtherSTATE LICENSE
TXB22469Medicare UPIN
TX8D6192Medicare ID - Type Unspecified