Individual
DR. GEOFFRY DE GENNARO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(616) 391-3245
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301105483
MI
2085R0202X
Diagnostic Radiology Physician
Primary
M-15099
ID
Other
Enumeration date
06/24/2014
Last updated
07/23/2020
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