Provider Demographics
NPI:1114107232
Name:GEISER, DAVID S (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GEISER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24931 SARANAC CT
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8911
Mailing Address - Country:US
Mailing Address - Phone:239-822-2915
Mailing Address - Fax:833-968-0319
Practice Address - Street 1:24931 SARANAC CT
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-8911
Practice Address - Country:US
Practice Address - Phone:239-822-2915
Practice Address - Fax:833-968-0319
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5048103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59527OtherBC/BS
FL59527AMedicare PIN