Healthcare Provider Details

I. General information

NPI: 1841616034
Provider Name (Legal Business Name): CODY GEDDES D.O,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD STE 203
ARCADIA CA
91007-9273
US

IV. Provider business mailing address

825 S MYRTLE AVE UNIT 507
MONROVIA CA
91016-8623
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-1190
  • Fax:
Mailing address:
  • Phone: 702-713-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0088879
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: