Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 04-17234 | KS |
NPI | 1871502294 |
---|---|
Provider Name | Dr. Dick Allen Geis |
First Address | Topeka, KS 66618-5001 |
Second Address | Topeka, KS 66604-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17384 | (02) | KS |