Basic Information
| Provider Information | |||||||||
| NPI: | 1447362520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEY | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 SE TECH CENTER DRIVE | ||||||||
| Address2: | SUITE #155 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986835521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605149040 | ||||||||
| FaxNumber: | 3605149041 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 MONTEGO STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259370404 | ||||||||
| FaxNumber: | 9259371340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | G82135 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | G82135 | 01 | CA | BLUE CROSS OF CA | OTHER | P00052861 | 01 | RAILROAD MEDICARE | OTHER | 00G821350 | 05 | CA | MEDICAID |