Healthcare Provider Details

I. General information

NPI: 1740417518
Provider Name (Legal Business Name): CAROL GEDDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 SEMINOLE BLVD
SEMINOLE FL
33772-5931
US

IV. Provider business mailing address

4278 28TH ST N
ST PETERSBURG FL
33714-3922
US

V. Phone/Fax

Practice location:
  • Phone: 727-392-8033
  • Fax: 727-392-9578
Mailing address:
  • Phone: 727-526-9135
  • Fax: 727-526-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME114069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: