Provider Demographics
NPI:1013078344
Name:JUDY, CARY JOHN (DO)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:JOHN
Last Name:JUDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:95 E CENTER
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634
Practice Address - Country:US
Practice Address - Phone:435-528-7227
Practice Address - Fax:435-528-2175
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51726651204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006001003Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
UT000006001Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
UTH40594Medicare UPIN