Provider Demographics
NPI:1427125129
Name:JUDY, LAWRENCE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:JUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:JUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9372
Mailing Address - Fax:812-858-4545
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9372
Practice Address - Fax:812-858-4545
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031630A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000109467OtherANTHEM
IN100138750Medicaid
KY64754476OtherKY MEDICAID
IN700004854Medicare PIN
IN849820JMedicare PIN
KY64754476OtherKY MEDICAID
IN100138750Medicaid