=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508800566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN STEVEN GERAGHTY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6746 S REVERE PKWY STE 180
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-6763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-632-3640
-----------------------------------------------------
Fax | 303-632-3642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6746 S REVERE PKWY STE 180
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-6763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-632-3640
-----------------------------------------------------
Fax | 303-632-3642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33711
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------