Provider Demographics
NPI:1154329357
Name:HEBERT, JUDY E (PA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:E
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5506
Mailing Address - Country:US
Mailing Address - Phone:409-722-4321
Mailing Address - Fax:409-729-2332
Practice Address - Street 1:2200 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5506
Practice Address - Country:US
Practice Address - Phone:409-722-4321
Practice Address - Fax:409-729-2332
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N4958OtherBCBS INDIVIDUAL NUMBER
TXS43633Medicare UPIN
TX8N4958OtherBCBS INDIVIDUAL NUMBER