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General NPI Number Information
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NPI Number | 1821006263
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Entity Type | Individual
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Provider Name | JACK GEOULA M,D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2700 DOLBEER ST ST JOSEPH HOSPITAL - EUREKA
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City | EUREKA
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State | CA
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Zip | 95501-4736
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Country | US
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Telephone | 707-845-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1997
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A94898
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License Number State | CA
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