Healthcare Provider Details

I. General information

NPI: 1437127685
Provider Name (Legal Business Name): PATRICIA C DEISLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA C GEORGE-DEISLER MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CENTURY MEDICAL DR STE B
TITUSVILLE FL
32796-2157
US

IV. Provider business mailing address

95 BULLDOG BLVD STE 202
MELBOURNE FL
32901-3188
US

V. Phone/Fax

Practice location:
  • Phone: 321-529-6202
  • Fax: 321-802-6864
Mailing address:
  • Phone: 321-727-2990
  • Fax: 321-724-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD203562
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME13887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: