Provider Demographics
NPI:1861411225
Name:DAVIS, JUDSON T (DPM)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1955 DOMINION WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1480
Mailing Address - Country:US
Mailing Address - Phone:719-533-0200
Mailing Address - Fax:719-533-2445
Practice Address - Street 1:1955 DOMINION WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1480
Practice Address - Country:US
Practice Address - Phone:719-533-0200
Practice Address - Fax:719-533-2445
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO653213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804240Medicare PIN
COV07757Medicare UPIN