Provider Demographics
NPI:1477873008
Name:GEARY, PAUL DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DOUGLAS
Last Name:GEARY
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 1:149 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7864
Mailing Address - Country:US
Mailing Address - Phone:651-636-0286
Mailing Address - Fax:651-636-0286
Practice Address - Street 1:149 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-7864
Practice Address - Country:US
Practice Address - Phone:651-636-0286
Practice Address - Fax:651-636-0286
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF37229Medicare UPIN