Provider Demographics
NPI:1952345514
Name:STILLER, GEOFFREY D (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:D
Last Name:STILLER
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 1:805 W 5TH AVE STE 619
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2802
Mailing Address - Country:US
Mailing Address - Phone:509-747-5773
Mailing Address - Fax:509-960-4063
Practice Address - Street 1:805 W 5TH AVE STE 619
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2802
Practice Address - Country:US
Practice Address - Phone:509-747-5773
Practice Address - Fax:509-960-4063
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044186174400000X, 208600000X
IDM8333174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807010600Medicaid
WA2128848Medicaid
ID807010600Medicaid
WA8854562Medicare ID - Type Unspecified
ID1128528Medicare ID - Type Unspecified