Active NPI
Mary Dan Eades, MD
- General Practice Physician
- Boulder, CO
National Provider Identifier
1164790994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 36065
- Practice address
- 6525 Gunpark Dr # 150-504
Boulder, CO 80301-3346 - Phone
- (720) 340-6306
- Fax
- (805) 565-3142
- NPI assigned
- Dec 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 36065 | CO | Primary |
Addresses
Primary practice location
6525 Gunpark Dr # 150-504
Boulder, CO 80301-3346
Mailing address
6525 Gunpark Dr # 150-504
Boulder, CO 80301-3346
Phone (720) 340-6306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36065 | CO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323216000000",
"number": "1164790994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6525 GUNPARK DR # 150-504",
"city": "BOULDER",
"state": "CO",
"postal_code": "803013346",
"telephone_number": "720-340-6306",
"fax_number": "805-565-3142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6525 GUNPARK DR # 150-504",
"city": "BOULDER",
"state": "CO",
"postal_code": "803013346",
"telephone_number": "720-340-6306",
"fax_number": "805-565-3142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EADES",
"first_name": "MARY DAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-07",
"last_updated": "2011-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CO",
"license": "36065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.