Provider Demographics
NPI:1407903396
Name:DAY, GEOFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:DAY
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 1:440 SCOTT ROLEN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2700
Mailing Address - Country:US
Mailing Address - Phone:812-482-5656
Mailing Address - Fax:812-482-9758
Practice Address - Street 1:440 SCOTT ROLEN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2700
Practice Address - Country:US
Practice Address - Phone:812-482-5656
Practice Address - Fax:812-482-9758
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063447A207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200907350Medicaid
IN200907350Medicaid
IN898190O4Medicare PIN