Individual
GORDON TADEWALDT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
444 BRUCE ST, YREKA, CA 96097-3450
(530) 842-7297
(530) 842-9054
Mailing address
PO BOX 1206, YREKA, CA 96097-1206
(530) 842-7297
(530) 842-9054
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G78660
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G786600
—
CA
Enumeration date
06/08/2005
Last updated
07/09/2007
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