Basic Information
| Provider Information | |||||||||
| NPI: | 1144261736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDGE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633819 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652923000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1125 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651015227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736325436 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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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 | 207P00000X | 31777 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000848449A | 05 | GA | MEDICAID | 009913050 | 05 | AL | MEDICAID | 009941583 | 05 | AL | MEDICAID | 3845256 | 05 | TN | MEDICAID | 3126986 | 01 | TN | BLUE CROSS | OTHER | P00233188 | 01 | MO | RAILROAD MEDICARE | OTHER | 000848449B | 05 | GA | MEDICAID | 3126988 | 01 | TN | BLUE CROSS | OTHER | 3845255 | 05 | TN | MEDICAID | P00269092 | 01 | TN | RAILROAD MEDICARE | OTHER | 203290838 | 05 | MO | MEDICAID |