Provider Demographics
NPI:1962600452
Name:LEDGERWOOD, GEOFF TYLER (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFF
Middle Name:TYLER
Last Name:LEDGERWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-695-6106
Mailing Address - Fax:
Practice Address - Street 1:11960 LIONESS WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5640
Practice Address - Country:US
Practice Address - Phone:303-695-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ68612208800000X
CO48095208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology