Provider Demographics
NPI:1063593267
Name:JUDGE, DEEPINDER KAUR (MD)
Entity type:Individual
Prefix:
First Name:DEEPINDER
Middle Name:KAUR
Last Name:JUDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 S WELLS STREET
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-4198
Mailing Address - Country:US
Mailing Address - Phone:361-782-5241
Mailing Address - Fax:361-782-7495
Practice Address - Street 1:1013 S WELLS ST
Practice Address - Street 2:A
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-4045
Practice Address - Country:US
Practice Address - Phone:361-782-3560
Practice Address - Fax:361-782-5627
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117000301Medicaid
TX117000302Medicaid
TX11700303Medicaid
G97563Medicare UPIN
TX117000302Medicaid
TX11700303Medicaid
TX89Y618Medicare PIN