Provider Demographics
NPI:1245525302
Name:SAFFORD, JUDITH M (LMT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:SAFFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 334
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:88039-0334
Mailing Address - Country:US
Mailing Address - Phone:575-539-2114
Mailing Address - Fax:
Practice Address - Street 1:18 CIRCLE DR.
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NM
Practice Address - Zip Code:88039
Practice Address - Country:US
Practice Address - Phone:575-539-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist