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1346456399

NPI Code Detail

MEDICARE: DR. GEOFFREY DOUGLAS MD

MEDICARE: DR. GEOFFREY DOUGLAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD.32676	AL
2	2086S0102X	Surgical Critical Care Physician	63460	WI
3	2086S0102X	Surgical Critical Care Physician	16532	NV
4	2086S0127X	Trauma Surgery Physician	ME127855	FL
5	208600000X	Surgery Physician	63460	WI
6	208600000X	Surgery Physician	A101528	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346456399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY DOUGLAS MD

Provider Business Mailing Address
First Line	:	3016 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1973
Country	:	US
Telephone Number	:	702-218-0915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 W CHARLESTON BLVD STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2354
Country	:	US
Telephone Number	:	701-671-5150
Fax Number	:	702-384-6493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	02/04/2022

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Directions to “ DR. GEOFFREY DOUGLAS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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