Provider Demographics
NPI:1447308010
Name:GEDDES, JAMES D
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:GEDDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 GENERAL CAVAZOS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7129
Mailing Address - Country:US
Mailing Address - Phone:361-592-5284
Mailing Address - Fax:361-592-1677
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7129
Practice Address - Country:US
Practice Address - Phone:361-592-5284
Practice Address - Fax:361-592-1677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100255201Medicaid
TX00TM62Medicare ID - Type Unspecified
TX100255201Medicaid