Provider Demographics
NPI:1750450540
Name:NAUDE, GIDEON PIETER (MD)
Entity Type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:PIETER
Last Name:NAUDE
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:PO BOX 3833
Mailing Address - Street 2:137 SOUTH SHEPHERD STREET
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-588-8777
Mailing Address - Fax:209-533-3263
Practice Address - Street 1:137 SOUTH SHEPHERD STREET
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-588-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53424208600000X
CA53424207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5059135Medicaid
CA00A534241Medicare ID - Type Unspecified
G66194Medicare UPIN