Provider Demographics
NPI:1740276542
Name:JUDD, THOMAS K (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:JUDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SAINT CHARLES AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4637
Mailing Address - Country:US
Mailing Address - Phone:504-412-1444
Mailing Address - Fax:
Practice Address - Street 1:3700 SAINT CHARLES AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4637
Practice Address - Country:US
Practice Address - Phone:504-412-1444
Practice Address - Fax:504-412-1497
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014758207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1394220Medicaid
LA1394220Medicaid
LA5J620Medicare PIN
LA5J620CR97Medicare PIN