Provider Demographics
NPI:1912998709
Name:JUDA, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:JUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:JUDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:350 WILLET AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2104
Mailing Address - Country:US
Mailing Address - Phone:239-810-3947
Mailing Address - Fax:
Practice Address - Street 1:350 WILLET AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2104
Practice Address - Country:US
Practice Address - Phone:239-810-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97756207LC0200X
IN01086955A207L00000X, 207LC0200X
FLME97756207LC0200X, 207RC0200X
MA223410207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278780600Medicaid
G88754Medicare UPIN
FL278780600Medicaid
FLAH166ZMedicare PIN
FLAH166XMedicare PIN