MEDICARE: JAMES KELSO GUDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	00G126270	CA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	00G126260	CA
3	207RP1001X	Pulmonary Disease Physician	00G126260	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235194697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KELSO GUDE MD

Provider Business Mailing Address
First Line	:	6800 PALM AVE
Second Line	:	SUITE K
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4269
Country	:	US
Telephone Number	:	707-824-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PALM AVE
Second Line	:	SUITE K
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4269
Country	:	US
Telephone Number	:	707-824-0882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	03/08/2013

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