Provider Demographics
NPI:1447230479
Name:JUDSON, DONNA S (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:JUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-0533
Mailing Address - Country:US
Mailing Address - Phone:850-476-0559
Mailing Address - Fax:850-476-0599
Practice Address - Street 1:2400 S HIGHWAY 29
Practice Address - Street 2:STE 306
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-5808
Practice Address - Country:US
Practice Address - Phone:850-476-0559
Practice Address - Fax:850-476-0599
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 73208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41382OtherBLUE CROSS BLUE SHIELD FL
FLP00461851OtherRAILROAD MEDICARE
AL591-97072OtherBCBS ALABAMA
FLA196OtherHEALTH FIRST NETWORK
FL253194100Medicaid
AL591-97072OtherBCBS ALABAMA
FLG13826Medicare UPIN