=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255302527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISE WEINRICH GEARY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 10/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1955 22ND AVE VERO BEACH DERMATOLOGY
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-299-0085
-----------------------------------------------------
Fax | 772-978-4193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1955 22ND AVE VERO BEACH DERMATOLOGY
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-299-0085
-----------------------------------------------------
Fax | 772-978-4193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 26404
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 26404
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------