Provider Demographics
NPI:1932168754
Name:EASLEY, JUDY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:A
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CIMARRON CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9722
Mailing Address - Country:US
Mailing Address - Phone:952-681-0970
Mailing Address - Fax:
Practice Address - Street 1:550 OSBORNE RD NE
Practice Address - Street 2:RT. 52840
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2718
Practice Address - Country:US
Practice Address - Phone:763-236-5000
Practice Address - Fax:763-236-3524
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32028207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1031906OtherPREFERRED ONE
MN523P9EAOtherBCBS OF MN
MN142167OtherUCARE
MN04-07812OtherMEDICA
MN2443412OtherAMERICA'S PPO
MN830707500Medicaid
MNHP10369OtherHEALTH PARTNERS
MN0408822OtherMEDICA CHOICE
MN110010410Medicare ID - Type Unspecified
MN2443412OtherAMERICA'S PPO
MN142167OtherUCARE