Provider Demographics
NPI:1457309254
Name:YANCEY, JUDITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:M
Other - Last Name:YANCEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7550 W UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7608
Mailing Address - Country:US
Mailing Address - Phone:352-727-4911
Mailing Address - Fax:352-505-5211
Practice Address - Street 1:7550 WEST UNIVERSITY AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7608
Practice Address - Country:US
Practice Address - Phone:352-727-4911
Practice Address - Fax:352-505-5211
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME513802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052303800Medicaid
FL270855OtherAVMED
FL239216OtherAVMED
FLP01188671OtherRAILROAD MEDICARE
FL07302XMedicare PIN
FL239216OtherAVMED
FL052303800Medicaid
FL270855OtherAVMED
FL270855OtherAVMED
FL052303800Medicaid