Provider Demographics
NPI:1821342973
Name:GEISS, ROGER WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIAM
Last Name:GEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 ILLINI DR
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2576
Mailing Address - Country:US
Mailing Address - Phone:309-671-8440
Mailing Address - Fax:309-671-8434
Practice Address - Street 1:1 ILLINI DR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2576
Practice Address - Country:US
Practice Address - Phone:309-671-8440
Practice Address - Fax:309-671-8434
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.054573207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology