Basic Information
| Provider Information | |||||||||
| NPI: | 1063593267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDGE | ||||||||
| FirstName: | DEEPINDER | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1013 S WELLS STREET | ||||||||
| Address2: | |||||||||
| City: | EDNA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779574198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617825241 | ||||||||
| FaxNumber: | 3617827495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1013 S WELLS ST | ||||||||
| Address2: | A | ||||||||
| City: | EDNA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779574045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617823560 | ||||||||
| FaxNumber: | 3617825627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | K8243 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 117000301 | 05 | TX | MEDICAID | 117000302 | 05 | TX | MEDICAID | 11700303 | 05 | TX | MEDICAID |