Tardy, Jude I

Tardy, Jude I is an individual health care provider with primary practice located at 417 State St Suite 330, Bangor ME 04401-6630. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Tardy, Jude I can be contacted via phone (207) 973-8881.

Contact Information

Primary practice address
417 State St Suite 330 Bangor ME 04401-6630
Phone: (207) 973-8881
Fax: (207) 973-8880
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA699 Maine

Profile Details

NPI number 1508822586
LBN Legal business name Tardy, Jude I
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Oct 18th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508822586 NPPES
Maine MEDICAID 266110099

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