Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 036078239 | IL |
Y | 2086S0120X | Pediatric Surgery | ME129728 | FL |
NPI | 1376725101 |
---|---|
Provider Name | Dr. Grant H Geissler |
First Address | Clearwater, FL 33757-8744 |
Second Address | Tampa, FL 33607-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 03/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019487300 | (05) | FL |
036078239 | (05) | IL |
1633575 | BCBS PROVIDER ID (01) | IL |
37146364501 | ADVOCATE HLTH PARTNERS ID (01) | IL |
F38216 | (02) | IL |