Healthcare Provider Details

I. General information

NPI: 1982895819
Provider Name (Legal Business Name): ERIK D GEISSAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 NE VANCOUVER PLAZA DR STE 110
VANCOUVER WA
98662
US

IV. Provider business mailing address

PO BOX 4825
PORTLAND OR
97208-4825
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1728
Mailing address:
  • Phone: 360-882-2778
  • Fax: 360-604-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License NumberMD60599738
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD28373
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60599738
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: