Provider Demographics
NPI:1558484550
Name:JUDY, JONATHAN ALLEN (NP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:JUDY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2333 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1925
Mailing Address - Country:US
Mailing Address - Phone:415-600-1426
Mailing Address - Fax:415-600-3312
Practice Address - Street 1:2333 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1925
Practice Address - Country:US
Practice Address - Phone:415-600-1426
Practice Address - Fax:415-600-3312
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA670513363LA2100X
CA16228363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31155Medicare UPIN