Provider Demographics
NPI:1962710160
Name:W. FORREST JUDSON, MD, PA
Entity type:Organization
Organization Name:W. FORREST JUDSON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-681-8974
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:SUITE 310W
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-681-8974
Mailing Address - Fax:813-689-4573
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 310W
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-681-8974
Practice Address - Fax:813-689-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26707208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO645AMedicare PIN
FLD54040Medicare UPIN