Provider Demographics
NPI:1952405581
Name:JUDGE, ROBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:JUDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711
Mailing Address - Country:US
Mailing Address - Phone:260-589-2312
Mailing Address - Fax:260-589-3941
Practice Address - Street 1:1521 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711
Practice Address - Country:US
Practice Address - Phone:260-589-2312
Practice Address - Fax:260-589-3941
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031537A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200171050AMedicaid
IN200171050AMedicaid
IN153829Medicare Oscar/Certification
IN133750Medicare PIN