Provider Demographics
NPI:1124025218
Name:JUDD, MARC WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:WARREN
Last Name:JUDD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 SCIENCE DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2094
Mailing Address - Country:US
Mailing Address - Phone:805-531-9400
Mailing Address - Fax:805-531-9499
Practice Address - Street 1:301 SCIENCE DR
Practice Address - Street 2:SUITE 190
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2094
Practice Address - Country:US
Practice Address - Phone:805-531-9400
Practice Address - Fax:805-531-9499
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA66629208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66629OtherSTATE LICENSE
H80043Medicare UPIN
CAA66629OtherSTATE LICENSE