Provider Demographics
NPI:1366452310
Name:CHITTERS, GERALD D (M D)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:CHITTERS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 NORTH ST
Mailing Address - Street 2:#302
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3307
Mailing Address - Country:US
Mailing Address - Phone:303-545-5380
Mailing Address - Fax:303-402-0445
Practice Address - Street 1:954 NORTH ST
Practice Address - Street 2:#302
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3307
Practice Address - Country:US
Practice Address - Phone:303-545-5380
Practice Address - Fax:303-402-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO339532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC18021Medicare ID - Type Unspecified
COE97867Medicare UPIN