Basic Information
| Provider Information | |||||||||
| NPI: | 1821062027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIDGER | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1381 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074318234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1381 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074335494 | ||||||||
| FaxNumber: | 7074311427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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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 | 207Q00000X | G80051 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.