Provider Demographics
NPI:1811962590
Name:INGALLS, JUDITH A IV (MD)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:INGALLS
Suffix:IV
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2892
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-2892
Mailing Address - Country:US
Mailing Address - Phone:480-488-0575
Mailing Address - Fax:480-374-5253
Practice Address - Street 1:36800 N SIDEWINDER
Practice Address - Street 2:SUTIE A4
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-5848
Practice Address - Country:US
Practice Address - Phone:480-595-0431
Practice Address - Fax:480-595-2322
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ23364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD24489Medicare UPIN
AZZ117776Medicare PIN