Organization
JUDY PC
Active
Other names
CLAINE D JUDY D.O.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAINE DOYLE JUDY D.O. (PRESIDENT)
(208) 232-7434
Entity
Organization
Contact information
Practice address
500 S 11TH AVE, STE 501, POCATELLO, ID 83201
(208) 232-7434
(208) 233-6446
Mailing address
500 S 11TH AVE, STE 501, POCATELLO, ID 83201
(208) 232-7434
(208) 233-6446
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C143842
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806327500
—
ID
01
—
8N074
BLUE CROSS OF IDAHO
ID
Enumeration date
10/03/2006
Last updated
08/22/2007
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