Provider Demographics
NPI:1447387485
Name:GEORGITIS, WILLIAM JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHNSON
Last Name:GEORGITIS
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 1:1375 E 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5423
Mailing Address - Country:US
Mailing Address - Phone:303-764-4665
Mailing Address - Fax:303-764-4468
Practice Address - Street 1:1375 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5423
Practice Address - Country:US
Practice Address - Phone:303-764-4665
Practice Address - Fax:303-764-4468
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26358207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263581Medicaid
009674OtherKAISER-COMMERCIAL NUMBER
CO01263581Medicaid
009674OtherKAISER-COMMERCIAL NUMBER