Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 63460 | WI |
N | 208600000X | Surgeon | 63460 | WI |
N | 208200000X | Surgeon | A101528 | CA |
N | 208600000X | Surgeon | A101528 | CA |
N | 208200000X | Surgeon | MD.32676 | AL |
N | 208600000X | Surgeon | MD.32676 | AL |
N | 2086S0102X | Surgical Critical Care | 16532 | NV |
N | 2086S0102X | Surgical Critical Care | 63460 | WI |
Y | 2086S0127X | Trauma Surgeon | ME127855 | FL |
NPI | 1346456399 |
---|---|
Provider Name | Dr. Geoffrey Douglas |
First Address | Las Vegas, NV 89102-1973 |
Second Address | Las Vegas, NV 89102-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113025700 | (05) | FL |