Provider Demographics
NPI:1235194697
Name:GUDE, JAMES KELSO (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KELSO
Last Name:GUDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PALM AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4269
Mailing Address - Country:US
Mailing Address - Phone:707-824-0882
Mailing Address - Fax:
Practice Address - Street 1:6800 PALM AVE
Practice Address - Street 2:SUITE K
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4269
Practice Address - Country:US
Practice Address - Phone:707-824-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G126270207R00000X
CA00G126260207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G127260Medicaid
A38773Medicare UPIN
00G127260Medicare ID - Type Unspecified