Provider Demographics
NPI:1609211069
Name:MATHURA, JUDITH DEL CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:DEL CARMEN
Last Name:MATHURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:DEL CARMEN
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 POND CT STE 203
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2717
Mailing Address - Country:US
Mailing Address - Phone:386-259-4106
Mailing Address - Fax:866-554-1654
Practice Address - Street 1:110 POND CT STE 203
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2717
Practice Address - Country:US
Practice Address - Phone:386-259-4106
Practice Address - Fax:866-554-1654
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine