Provider Demographics
NPI:1578560942
Name:HEDBERG, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HEDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:165 S UNION BLVD
Practice Address - Street 2:STE 800
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2215
Practice Address - Country:US
Practice Address - Phone:303-988-2680
Practice Address - Fax:303-986-8057
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO23617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01236173Medicaid
CO01236173Medicaid
CON1684Medicare ID - Type Unspecified