Provider Demographics
NPI:1437199536
Name:HEATH, JUDITH W (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:HEATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:WOODING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-583-5816
Practice Address - Street 1:14416 W MEEKER BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5284
Practice Address - Country:US
Practice Address - Phone:623-583-5100
Practice Address - Fax:623-583-5816
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260323Medicaid
AZZ80462Medicare PIN
AZZ80460Medicare PIN
AZP00119959Medicare PIN
AZ260323Medicaid