Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 11841 | AL |
N | 208600000X | Surgeon | 11841 | AL |
Y | 2086S0120X | Pediatric Surgery | MD60183442 | WA |
NPI | 1407890510 |
---|---|
Provider Name | Keith E Georgeson |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000014166 | (05) | AL |
000014166 | BLUE CROSS (01) | AL |
00122960 | MISSISSIPPI MEDICAID (01) | MS |
009946695 | (05) | AL |
009961775 | (05) | AL |
051520177 | BLUE CROSS (01) | AL |
051523114 | BLUE CROSS (01) | AL |
37862742A | GEORGIA MEDICAID (01) | GA |
A40463 | HEALTHSPRING OF ALABAMA (01) | AL |
A40463 | VIVA (01) | AL |