Provider Demographics
NPI:1003344862
Name:THEDE, ALYSON ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:ANNE
Last Name:THEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:ENDICOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 RANCH ROAD 2222, BUILDING 1, STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:512-628-0465
Mailing Address - Fax:512-233-2711
Practice Address - Street 1:815 N 5TH AVE UNIT 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2884
Practice Address - Country:US
Practice Address - Phone:406-545-2555
Practice Address - Fax:406-545-2554
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12229855-1205207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery