Provider Demographics
NPI:1437177268
Name:GAEDE, GARY L (M D)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:GAEDE
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0537
Mailing Address - Country:US
Mailing Address - Phone:303-941-5425
Mailing Address - Fax:
Practice Address - Street 1:160C RIVERCREST DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5617
Practice Address - Country:US
Practice Address - Phone:303-941-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01257336Medicaid
CO01257336Medicaid
E23319Medicare UPIN