Basic Information
| Provider Information | |||||||||
| NPI: | 1093923468 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE, BOX 665 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852767790 | ||||||||
| FaxNumber: | 5852762497 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE, BOX 665 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852767790 | ||||||||
| FaxNumber: | 5852762497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 47303 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD47303 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 8302 | SD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 278850 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.