Provider Demographics
NPI:1134254782
Name:GEOFFRAY, DOLORES JOAN (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:JOAN
Last Name:GEOFFRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROCK PL
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6383
Mailing Address - Country:US
Mailing Address - Phone:985-727-0017
Mailing Address - Fax:425-928-0494
Practice Address - Street 1:71107 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7243
Practice Address - Country:US
Practice Address - Phone:985-705-3883
Practice Address - Fax:425-928-0494
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019051207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1918121Medicaid
LA1918121Medicaid
LA55578Medicare ID - Type Unspecified