Provider Demographics
NPI:1639128440
Name:LUBBERS, JUDITH RICHARDSON (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:RICHARDSON
Last Name:LUBBERS
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 1:22498 CLAY LICK RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9749
Mailing Address - Country:US
Mailing Address - Phone:740-380-9241
Mailing Address - Fax:
Practice Address - Street 1:1166 DUBLIN RD STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1081
Practice Address - Country:US
Practice Address - Phone:740-380-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054890L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0945062Medicaid
P00252404OtherMEDICARE RR HOCKING
OH000000367000OtherBCBS
000000315927OtherHOCKING BCBS
OH0945062Medicaid
OH000000367000OtherBCBS
E76388Medicare UPIN