Provider Demographics
NPI:1467544403
Name:DEGRAFF, JUDITH KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:KAY
Last Name:DEGRAFF
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:PO BOX 6213
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0213
Mailing Address - Country:US
Mailing Address - Phone:402-440-8636
Mailing Address - Fax:402-486-0243
Practice Address - Street 1:3512 S 75TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-4607
Practice Address - Country:US
Practice Address - Phone:402-440-8636
Practice Address - Fax:402-486-0243
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470834574-00Medicaid
NE470834574-00Medicaid