Provider Demographics
NPI:1275574246
Name:JOHNSON, JUDY G (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 ELEONORE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4310
Mailing Address - Country:US
Mailing Address - Phone:504-891-0977
Mailing Address - Fax:
Practice Address - Street 1:1037 ELEONORE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4310
Practice Address - Country:US
Practice Address - Phone:504-891-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10027R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1972410Medicaid
MS01887809Medicaid
MS01887809Medicaid
LA5R915CT29Medicare PIN
LA5R915Medicare ID - Type Unspecified
LAP00340577Medicare PIN
LAF66328Medicare UPIN