Provider Demographics
NPI:1730189663
Name:JUDY, ALEXANDER SHELTON (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SHELTON
Last Name:JUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4631
Mailing Address - Country:US
Mailing Address - Phone:900-677-6904
Mailing Address - Fax:906-774-7279
Practice Address - Street 1:440 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4631
Practice Address - Country:US
Practice Address - Phone:900-677-6904
Practice Address - Fax:906-774-7279
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI063937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080099765OtherRAILROAD MEDICARE
WI32319900Medicaid
MI3366460Medicaid
MI3366460Medicaid
WI32319900Medicaid
MI233885Medicare Oscar/Certification