Provider Demographics
NPI:1588856298
Name:PENTON, JUDSON LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:LEIGH
Last Name:PENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:108 RUE LOUIS XIV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5739
Mailing Address - Country:US
Mailing Address - Phone:337-235-8007
Mailing Address - Fax:337-235-8008
Practice Address - Street 1:108 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5739
Practice Address - Country:US
Practice Address - Phone:337-235-8007
Practice Address - Fax:337-235-8008
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.202273207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1237701Medicaid
LA4Q284D628Medicare PIN