Provider Demographics
NPI:1831197920
Name:BRANDEIS, JUDSON M (MD)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:M
Last Name:BRANDEIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PARK PL STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4460
Mailing Address - Country:US
Mailing Address - Phone:925-255-7867
Mailing Address - Fax:925-725-4987
Practice Address - Street 1:2222 EAST ST
Practice Address - Street 2:STE 240
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2084
Practice Address - Country:US
Practice Address - Phone:925-689-6211
Practice Address - Fax:925-689-3857
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA62541208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067920Medicaid
340018831OtherRR MEDICARE
340018831OtherRR MEDICARE
R29527Medicare UPIN