Provider Demographics
NPI:1023336922
Name:WRIGHT, JUDY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LEE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:WRIGHT
Other - Last Name:BARTOLONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1006 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4143
Mailing Address - Country:US
Mailing Address - Phone:309-828-7876
Mailing Address - Fax:
Practice Address - Street 1:1006 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4143
Practice Address - Country:US
Practice Address - Phone:309-828-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.056291207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37311Medicare UPIN