Provider Demographics
NPI:1881862407
Name:MARTIN, JUDY K (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:K
Last Name:MARTIN
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 1:8201 MISSION RD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5212
Mailing Address - Country:US
Mailing Address - Phone:913-649-0923
Mailing Address - Fax:
Practice Address - Street 1:8201 MISSION RD
Practice Address - Street 2:SUITE 261
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5212
Practice Address - Country:US
Practice Address - Phone:913-649-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04248892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry