Provider Demographics
NPI:1275627846
Name:MARTIN, JUDSON C (MD)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 WEST 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4634
Mailing Address - Country:US
Mailing Address - Phone:308-635-3911
Mailing Address - Fax:308-635-3130
Practice Address - Street 1:329 WEST 40TH STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4634
Practice Address - Country:US
Practice Address - Phone:308-635-3911
Practice Address - Fax:308-635-3130
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14554207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7778272Medicaid
WY10160Medicare ID - Type Unspecified
NED05134Medicare UPIN
NE277618Medicare ID - Type Unspecified