Basic Information
| Provider Information | |||||||||
| NPI: | 1821008582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13550 SW 120TH ST | ||||||||
| Address2: | STE 502 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136328861 | ||||||||
| FaxNumber: | 8139771742 | ||||||||
| Practice Location | |||||||||
| Address1: | 13701 BRUCE B DOWNS BLVD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136328861 | ||||||||
| FaxNumber: | 8139771742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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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 | 207QG0300X | ME90662 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 052602901 | 05 | FL | MEDICAID |