Healthcare Provider Details

I. General information

NPI: 1750450540
Provider Name (Legal Business Name): GIDEON PIETER NAUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SOUTH SHEPHERD STREET
SONORA CA
95370
US

IV. Provider business mailing address

PO BOX 3833 137 SOUTH SHEPHERD STREET
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-588-8777
  • Fax:
Mailing address:
  • Phone: 209-588-8777
  • Fax: 209-533-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA53424
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number53424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: