Provider Demographics
NPI:1497999205
Name:JUDD, JOHN ALTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALTON
Last Name:JUDD
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 1:5100 FOREST GROVE PL
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9677
Mailing Address - Country:US
Mailing Address - Phone:502-382-0158
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:5100 FOREST GROVE PL
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9677
Practice Address - Country:US
Practice Address - Phone:502-382-0158
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201196630AMedicaid
KY7100252650Medicaid
IN201196630AMedicaid
KYK103770Medicare PIN