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NPI Code Detail

MEDICARE: DR. GERALD CELEBRE EDD

MEDICARE: DR. GERALD CELEBRE EDD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY.0003073CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1COA105814OTHERCOMEDICARE INDIVIDUAL PTAN

General Provider Information

NPI Number : 1407036791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALD CELEBRE EDD
Provider Business Mailing Address
First Line : 4851 INDEPENDENCE ST
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-6715
Country : US
Telephone Number : 303-425-0300
Fax Number : 303-432-5071
Provider Business Practice Location Address
First Line : 12055 W 2ND PL
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-1506
Country : US
Telephone Number : 303-425-4480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2007
Last Update Date : 06/10/2021

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Directions to “ DR. GERALD CELEBRE EDD” Practice Location

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