Provider Demographics
NPI:1801848171
Name:EMERSON, GEOFFREY GUY (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:GUY
Last Name:EMERSON
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 1:710 E 24TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3846
Mailing Address - Country:US
Mailing Address - Phone:612-871-2292
Mailing Address - Fax:952-460-5274
Practice Address - Street 1:710 E 24TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3846
Practice Address - Country:US
Practice Address - Phone:612-871-2292
Practice Address - Fax:952-460-5274
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25646207WX0107X
MN49508207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34783400Medicaid
OR023134Medicaid
MN750052000Medicaid
I31715Medicare UPIN
OR023134Medicaid