Provider Demographics
NPI:1184629032
Name:MARTIN, JUDSON F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:F
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:17050 BAXTER ROAD
Practice Address - Street 2:CHESTERFIELD SURGERY CENTER, LLC, SUITE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005
Practice Address - Country:US
Practice Address - Phone:636-537-0122
Practice Address - Fax:636-537-0480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2016-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO103080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206666117Medicaid
MOF59344Medicare UPIN
MO926784396Medicare ID - Type Unspecified