Healthcare Provider Details

I. General information

NPI: 1336497734
Provider Name (Legal Business Name): MR. CHARLES M GEIGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVL HOSPITAL ROTA PSC 819 BOX 18
FPO AE
09645
US

IV. Provider business mailing address

EODMU 8 N9 UNIT 60531
FPO AE
09501
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-1923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: