Provider Demographics
NPI:1881624468
Name:GEITZ, JAMES MELVIN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MELVIN
Last Name:GEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:M
Other - Last Name:GEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-0907
Mailing Address - Country:US
Mailing Address - Phone:620-342-2521
Mailing Address - Fax:620-342-6520
Practice Address - Street 1:1301 WEST 12TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-0970
Practice Address - Country:US
Practice Address - Phone:620-342-2521
Practice Address - Fax:620-342-6520
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
052725GEMedicare ID - Type Unspecified
B68277Medicare UPIN