Provider Demographics
NPI:1285730473
Name:BLAND, JUDEE LYNN (MD)
Entity type:Individual
Prefix:
First Name:JUDEE
Middle Name:LYNN
Last Name:BLAND
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 1:1119 HILLDALE CIR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3517
Mailing Address - Country:US
Mailing Address - Phone:573-424-9075
Mailing Address - Fax:
Practice Address - Street 1:1119 HILLDALE CIR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3517
Practice Address - Country:US
Practice Address - Phone:573-424-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018976207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758908OtherHEALTHLINK
MO206988107Medicaid
MO111238OtherBLUE SHIELD
MOP00342845OtherRR MEDICARE
MO206988107Medicaid
I63362Medicare UPIN