1447757349 NPI number — RAGE LUKE UNDERWOOD GERINGER MD

Table of content: RAGE LUKE UNDERWOOD GERINGER MD (NPI 1447757349)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447757349 NPI number — RAGE LUKE UNDERWOOD GERINGER MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
GERINGER

Provider First Name:
RAGE

Provider Middle Name:
LUKE UNDERWOOD

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447757349

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
12/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 S GLENDO HWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
GLENDO

Provider Business Mailing Address State Name:
WY

Provider Business Mailing Address Postal Code:
82213-9616

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
307-331-3375

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10099 RIDGEGATE PKWY STE 200

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
LONE TREE

Provider Business Practice Location Address State Name:
CO

Provider Business Practice Location Address Postal Code:
80124-5532

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
307-331-3375

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
04/09/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 207R00000X , with the licence number: 8669 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .