Healthcare Provider Details

I. General information

NPI: 1639185044
Provider Name (Legal Business Name): MICHAEL JAMES GERAGHTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 LEMAY AVE
FORT COLLINS CO
80524
US

IV. Provider business mailing address

2008 CARIBOU DR
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8600
  • Fax: 970-495-7619
Mailing address:
  • Phone: 970-484-4757
  • Fax: 970-484-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7597A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37953
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21193
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: