Provider Demographics
NPI:1295707099
Name:JONES, JUDY LEE (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:JONES
Other - Last Name:ARMOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 S WOODRUFF
Mailing Address - Street 2:SUITE 19
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-529-2603
Mailing Address - Fax:208-529-0451
Practice Address - Street 1:2001 S WOODRUFF
Practice Address - Street 2:SUITE 19
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-529-2603
Practice Address - Fax:208-529-0451
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005844OtherREGENCE BLUE SHIELD
ID46714OtherBLUE CROSS
ID000384000Medicaid
ID000384000Medicaid
ID000010005844OtherREGENCE BLUE SHIELD