Provider Demographics
NPI:1245410042
Name:JUDA, CASSIDY L (PA)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:L
Last Name:JUDA
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 1:1905 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4061
Mailing Address - Country:US
Mailing Address - Phone:406-587-4432
Mailing Address - Fax:406-587-7015
Practice Address - Street 1:1905 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4061
Practice Address - Country:US
Practice Address - Phone:406-587-4432
Practice Address - Fax:406-587-7015
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011003485OtherMEDICARE PTAN