Provider Demographics
NPI:1508800566
Name:GERAGHTY, JOHN STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:GERAGHTY
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 1:13111 E BRIARWOOD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3925
Mailing Address - Country:US
Mailing Address - Phone:303-632-3640
Mailing Address - Fax:303-632-3642
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3925
Practice Address - Country:US
Practice Address - Phone:303-632-3640
Practice Address - Fax:303-632-3642
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91909830Medicaid
CO91909830Medicaid
COC529138Medicare PIN