Provider Demographics
NPI:1942208608
Name:BLOCK, GEOFFREY DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:DOUGLAS
Last Name:BLOCK
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 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-773-2882
Mailing Address - Fax:
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-773-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041854E207RT0003X
PAMD041854E207RG0100X, 207RI0008X
CA131448207RG0100X
CAG131448207RI0008X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA672360Q1TMedicare PIN