Provider Demographics
NPI:1700042371
Name:HEUGEL, JUDSON RYAN (MD)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:RYAN
Last Name:HEUGEL
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 1:16233 SYLVESTER RD SW STE 230
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-242-7822
Mailing Address - Fax:
Practice Address - Street 1:16233 SYLVESTER RD SW STE 230
Practice Address - Street 2:SUITE 230
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-242-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071995208000000X
WAMD60511475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics