NPI 1336554740 · live from the CMS NPI Registry
Geoffry De Gennaro, M.D.
Radiology, Diagnostic Radiology in Boise, ID. National Provider Identifier 1336554740, active.
NPI record
| NPI | 1336554740 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 190 E Bannock St, Boise, ID 83712 |
| Practice phone | 208-381-2094 |
| Enumerated | June 24, 2014 |
| Last updated | July 23, 2020 |
| Sole proprietor | No |
| Other names | Geoff De Gennaro |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | 4301105483 (MI) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | M-15099 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.