Healthcare Provider Details

I. General information

NPI: 1154018364
Provider Name (Legal Business Name): MASON ANDREW GEDLAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY FL 1
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

14300 ORCHARD PKWY FL 1
WESTMINSTER CO
80023-9206
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-5560
  • Fax: 303-430-5565
Mailing address:
  • Phone: 303-430-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0073705
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: