Provider Demographics
NPI:1780846592
Name:JUDGE, JOSHUA M (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:JUDGE
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 1:800 ROSE STREET
Mailing Address - Street 2:C224
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-6346
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:C224
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP3232086S0127X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTP323OtherKY MEDICAL LICENSE