Provider Demographics
NPI:1598719197
Name:NEGIN, GEOFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:A
Last Name:NEGIN
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 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3506
Mailing Address - Fax:
Practice Address - Street 1:63 BARKLEY CIR
Practice Address - Street 2:STE. 100 & 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:239-938-3500
Practice Address - Fax:239-278-0588
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00587312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
201712OtherAMERIGROUP
247618OtherCIGNA
ME58731OtherFL WC CERTIFICATE
1640772OtherFOCUS
FL371678300Medicaid
18060OtherBCBSFL
FLP00317967OtherRR MEDICARE FOR FLORIDA RADIOLOGY LEASING
FLP00317967OtherRR MEDICARE FOR FLORIDA RADIOLOGY LEASING
FL18060WMedicare PIN
FL300127797Medicare ID - Type UnspecifiedRR FL RAD CONSULT
FL300064847Medicare PIN
FL18060TMedicare PIN
201712OtherAMERIGROUP