Basic Information
| Provider Information | |||||||||
| NPI: | 1992922157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 SHADYBROOK DR | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751153029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143710474 | ||||||||
| FaxNumber: | 2146896482 | ||||||||
| Practice Location | |||||||||
| Address1: | 3330 S LANCASTER RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143710474 | ||||||||
| FaxNumber: | 2146896482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363A00000X | PA00034 | TX | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA00034 | TX | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.