Basic Information
| Provider Information | |||||||||
| NPI: | 1053415364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEY | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17310 WRIGHT ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681302405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8332286889 | ||||||||
| FaxNumber: | 8778530376 | ||||||||
| Practice Location | |||||||||
| Address1: | 17310 WRIGHT ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681302405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8332286889 | ||||||||
| FaxNumber: | 8778530376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2006 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 0101237007 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | 16842 | ND | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 2006-00792 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 010112982 541581185 | 05 | VA | MEDICAID |