Individual
CHARLES RAEBURN JUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 RANDOLPH ST, RADFORD, VA 24141-2428
(540) 639-5300
(540) 639-4653
Mailing address
600 RANDOLPH ST, RADFORD, VA 24141-2428
(540) 639-5300
(540) 639-4653
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101050262
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010172942
—
VA
05
—
5639719
—
VA
Enumeration date
06/28/2005
Last updated
09/27/2011
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