Provider Demographics
NPI:1427094192
Name:RAYMER, GEOFFREY S (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:S
Last Name:RAYMER
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:2326 18TH ST STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5362
Practice Address - Country:US
Practice Address - Phone:812-372-8680
Practice Address - Fax:812-372-5497
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048953207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200420960Medicaid
OH2398552Medicaid
OH2398552Medicaid
IN200420960Medicaid