Provider Demographics
NPI:1376725101
Name:GEISSLER, GRANT H (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:H
Last Name:GEISSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:3001 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-554-8384
Practice Address - Fax:813-443-8160
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360782392086S0120X
FLME1297282086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37146364501OtherADVOCATE HLTH PARTNERS ID
IL1633575OtherBCBS PROVIDER ID
IL036078239Medicaid
FL019487300Medicaid
ILK12397Medicare PIN
IL036078239Medicaid
ILK12396Medicare PIN