Provider Demographics
NPI:1104803931
Name:MCCULLEN, GEOFFREY M (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:M
Last Name:MCCULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6900 A ST
Mailing Address - Street 2:LINCOLN
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4120
Mailing Address - Country:US
Mailing Address - Phone:402-436-2000
Mailing Address - Fax:402-436-2090
Practice Address - Street 1:6900 A ST
Practice Address - Street 2:LINCOLN
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4120
Practice Address - Country:US
Practice Address - Phone:402-436-2000
Practice Address - Fax:402-436-2090
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME016484207XS0117X
NE21263207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061995513Medicaid
NE47061995513Medicaid