Doctor Name: | WAYNE FORREST JUDSON |
NPI Number: | 1962494146 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | ME26707 |
Business Practice Address: | 500 Vonderburg Dr Suite 310w Brandon, FL - 335115964 |
Business Phone Number: | 8136818974 |
Business Fax Number: | 8136894573 |
Mailing Address: | 500 Vonderburg Dr, Suite 310w BRANDON |
State: | FL |
Postal Code: | 335115964 |
Phone Number: | 8136818974 |
Fax Number: | 8136894573 |
NPI Enumeration Date: | 08/16/2005 |
NPI Last Update Date: | 01/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME26707 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |