Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 11169 | MS |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 11169 | MS |
NPI | 1194725374 |
---|---|
Provider Name | Prof. William Bennett Geissler |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-5114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116304 | (05) | MS |
11169 | LICENSE (01) | |
126102 | (05) | AL |
1990728 | (05) | LA |
200014928 | RAILROAD MEDICARE (01) | |
512I200005 | MEDICARE PTAN (01) | MS |
E51210 | (02) | |
P00462205 | RAILROAD MEDICARE PTAN (01) | MS |