Basic Information
| Provider Information | |||||||||
| NPI: | 1255430815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAEDE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 S PALM CANYON DR BLDG C | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922648354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609697770 | ||||||||
| FaxNumber: | 7609697771 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 S PALM CANYON DR BLDG C | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922648354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609697770 | ||||||||
| FaxNumber: | 7609697771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G86232 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.