Provider Demographics
NPI:1174888242
Name:GARST, GEOFFREY (MD, MPH)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:GARST
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27TH SOMG FLIGHT AND OPERATIONAL MEDICINE
Mailing Address - Street 2:224 W D.L. INGRAM AVENUE, BUILDING 1408
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 W D.L. INGRAM AVENUE, BUILDING 1408
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-904-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-1066207P00000X
OH35.143521171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine