Provider Demographics
NPI:1750447504
Name:AMES, GEOFFREY STILLMAN (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:STILLMAN
Last Name:AMES
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 430
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0430
Mailing Address - Country:US
Mailing Address - Phone:509-943-3934
Mailing Address - Fax:509-943-4016
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:10
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-943-3934
Practice Address - Fax:509-943-4016
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026961207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF36115Medicare UPIN