Provider Demographics
NPI:1568578987
Name:STILES, GEOFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:M
Last Name:STILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7910 FROST ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2795
Mailing Address - Country:US
Mailing Address - Phone:858-279-5599
Mailing Address - Fax:858-279-5848
Practice Address - Street 1:7910 FROST ST
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2795
Practice Address - Country:US
Practice Address - Phone:858-279-5599
Practice Address - Fax:858-279-5848
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G579340Medicaid
E60887Medicare UPIN
CAG57934Medicare ID - Type Unspecified