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General NPI Number Information
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NPI Number | 1275052458
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Entity Type | Organization
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Legal Business Name | PENINSULA SPINE INSTITUTE, PS
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 804 CALLAHAN DR STE A
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City | BREMERTON
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State | WA
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Zip | 98310-3307
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Country | US
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Telephone | 360-515-2555
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Fax | 206-892-9652
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Provider Business Mailing Address
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Address Line | 2503 CLIFFSIDE LN NW APT V201
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City | GIG HARBOR
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State | WA
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Zip | 98335-6885
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Country | US
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Telephone | 360-515-2555
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Fax | 206-892-9652
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS JAMES GEYER
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Credential | MD
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Telephone | 360-515-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD00048961
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License Number State | WA
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