Healthcare Provider Details

I. General information

NPI: 1598755068
Provider Name (Legal Business Name): MAURICE GEURTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HIGHWAY 60
SOCORRO NM
87801-3914
US

IV. Provider business mailing address

4 HONDO TRL
SANTA FE NM
87508-5936
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-1140
  • Fax:
Mailing address:
  • Phone: 22-892-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-0894
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420010595
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: