Provider Demographics
NPI:1972616472
Name:MCDONALD, GEOFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:D
Last Name:MCDONALD
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 1:1214 SPRING ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3704
Mailing Address - Country:US
Mailing Address - Phone:812-283-3993
Mailing Address - Fax:812-283-7294
Practice Address - Street 1:1214 SPRING ST # 1
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-283-3993
Practice Address - Fax:812-283-7294
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043202A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464640Medicaid
122640OMedicare PIN
IN100464640Medicaid