Provider Demographics
NPI:1275565087
Name:DREW, GEOFFREY V (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:V
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E AVE DE LOS ARBOLES STE 203
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3017
Mailing Address - Country:US
Mailing Address - Phone:805-492-1015
Mailing Address - Fax:805-492-2035
Practice Address - Street 1:430 E AVE DE LOS ARBOLES STE 203
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3017
Practice Address - Country:US
Practice Address - Phone:805-492-1015
Practice Address - Fax:805-492-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44579261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44579FOtherMEDICARE PPIN
WA44579FOtherMEDICARE PPIN