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General NPI Number Information
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NPI Number | 1629107420
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Entity Type | Individual
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Provider Name | GEOFFREY M GEOGHEGAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 350 W COLUMBIA ST STE 420
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City | EVANSVILLE
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State | IN
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Zip | 47710-1782
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Country | US
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Telephone | 812-422-3254
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Fax | 812-426-6388
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Provider Business Mailing Address
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Address Line | 350 W COLUMBIA ST STE 420
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City | EVANSVILLE
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State | IN
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Zip | 47710-1782
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Country | US
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Telephone | 812-422-3254
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Fax | 812-426-6388
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2011016761
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License Number State | MO
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