Provider Demographics
NPI:1346238136
Name:GIRARDI, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:GIRARDI
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 1:3744 S. TIMBERLINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4334
Mailing Address - Country:US
Mailing Address - Phone:970-495-0506
Mailing Address - Fax:970-495-0485
Practice Address - Street 1:3744 S. TIMBERLINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4334
Practice Address - Country:US
Practice Address - Phone:970-495-0506
Practice Address - Fax:970-495-0485
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7058A208VP0014X
CO33258207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332584Medicaid
COP00647832OtherMEDICARE - RR
NE10026360700Medicaid
WY109533100Medicaid
CO050062212OtherMEDICARE - RR
NEXXXXXXXXX13Medicaid
COP00647832OtherMEDICARE - RR
WY109533100Medicaid
NEXXXXXXXXX13Medicaid