Provider Demographics
NPI:1902938848
Name:FOX, JUDITH B (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:B
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:BERNADETTE
Other - Last Name:NWAJIAKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:810 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1128
Mailing Address - Country:US
Mailing Address - Phone:402-426-2182
Mailing Address - Fax:
Practice Address - Street 1:810 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94772070Medicaid
COCOA105542Medicare PIN
CO94772070Medicaid