MEDICARE: DR. GEOFFREY A NEGIN MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME0058731	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00317967	OTHER	FL	RR MEDICARE FOR FLORIDA RADIOLOGY LEASING

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	201712	OTHER	AMERIGROUP
2	247618	OTHER	CIGNA
3	ME58731	OTHER	FL WC CERTIFICATE
4	1640772	OTHER	FOCUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	18060	OTHER	BCBSFL
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1598719197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY A NEGIN MD

Provider Business Mailing Address
First Line	:	8791 CONFERENCE DR
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5822
Country	:	US
Telephone Number	:	239-938-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 BARKLEY CIR
Second Line	:	STE. 100 & 101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4514
Country	:	US
Telephone Number	:	239-938-3500
Fax Number	:	239-278-0588

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/09/2014

63 BARKLEY CIR STE 104
FORT MYERS, FL
33907-4514

Practice Phone: 239-275-8452
Practice Fax: 239-274-3182