Provider Demographics
NPI:1841616034
Name:GEDDES, CODY (DO,)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:GEDDES
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S MYRTLE AVE UNIT 507
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8623
Mailing Address - Country:US
Mailing Address - Phone:702-713-5090
Mailing Address - Fax:
Practice Address - Street 1:622 W DUARTE RD STE 203
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9273
Practice Address - Country:US
Practice Address - Phone:626-446-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0088879207R00000X
CA14185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine