Provider Demographics
NPI:1093906315
Name:JUDD, NANCY P (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:P
Last Name:JUDD
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 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 11A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-362-7522
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 11A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-362-7522
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010006159207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273851366Medicaid