Provider Demographics
NPI:1134129687
Name:GEDDE, MARGARET
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:GEDDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E RAINBOW BLVD
Mailing Address - Street 2:# 120
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 E RAINBOW BLVD
Practice Address - Street 2:# 120
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2913
Practice Address - Country:US
Practice Address - Phone:719-239-0643
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42333208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78561Medicare UPIN
CO542778Medicare ID - Type Unspecified