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Organization
JUDE WATERBURY INC
Active
Organization
JUDE WATERBURY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDE WATERBURY MD (PHYSICIAN OWNER)
(916) 689-8606
Entity
Organization
Contact information
Practice address
8100 TIMBERLAKE WAY, #D, SACRAMENTO, CA 95823-5409
(916) 689-8606
Mailing address
8100 TIMBERLAKE WAY, #D, SACRAMENTO, CA 95823-5409
(916) 689-8606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A90991
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A909910
BLUE SHIELD
CA
05
—
00A909910
—
CA
01
—
DE3856
RAILROAD MEDICARE
CA
Enumeration date
05/22/2007
Last updated
04/04/2012
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