Provider Demographics
NPI:1245570639
Name:JUDEH, ASHRUF NABIH (IDC)
Entity Type:Individual
Prefix:MR
First Name:ASHRUF
Middle Name:NABIH
Last Name:JUDEH
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS LEYTE GULF (CG 55)
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09570
Mailing Address - Country:US
Mailing Address - Phone:619-873-6695
Mailing Address - Fax:
Practice Address - Street 1:USS LEYTE GULF (CG 55)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09570
Practice Address - Country:US
Practice Address - Phone:619-873-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman