Basic Information
| Provider Information | |||||||||
| NPI: | 1295712248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDERBERG | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE | ||||||||
| Address2: | BUILDING 5 SUITE 200 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034383999 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE | ||||||||
| Address2: | BUILDING 5 SUITE 200 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034383999 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 23139 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 82431900 | 05 | WI | MEDICAID | 84113438513 | 05 | NE | MEDICAID | 01231398 | 05 | CO | MEDICAID | U2432 | 05 | NM | MEDICAID | 103412000 | 05 | WY | MEDICAID | 3506685 | 05 | MT | MEDICAID | 051289901 | 05 | TX | MEDICAID | 100193790A | 05 | KS | MEDICAID | 7706680 | 05 | SD | MEDICAID |