Healthcare Provider Details

I. General information

NPI: 1972616472
Provider Name (Legal Business Name): GEOFFREY D MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 SPRING ST # 1
JEFFERSONVILLE IN
47130-3704
US

IV. Provider business mailing address

1214 SPRING ST SUITE 1
JEFFERSONVILLE IN
47130-3704
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-3993
  • Fax: 812-283-7294
Mailing address:
  • Phone: 812-283-3993
  • Fax: 812-283-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01043202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: