Healthcare Provider Details

I. General information

NPI: 1306054606
Provider Name (Legal Business Name): GEOFFREY A FUNK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SWISS AVENUE
DALLAS TX
75204-5900
US

IV. Provider business mailing address

3701 JUNIUS ST # CS11G006
DALLAS TX
75246-2026
US

V. Phone/Fax

Practice location:
  • Phone: 214-821-1599
  • Fax: 214-821-8985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberM5173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: