Provider Demographics
NPI:1972776888
Name:DAVIES, JUDSON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:D
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDD
Other - Middle Name:D
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3907
Mailing Address - Country:US
Mailing Address - Phone:402-397-9800
Mailing Address - Fax:402-397-7591
Practice Address - Street 1:111 S 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3907
Practice Address - Country:US
Practice Address - Phone:402-397-9800
Practice Address - Fax:402-397-7591
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27264208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0957630005Medicare PIN