Individual
JOHN KEVIN GEISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2290 SACRAMENTO ST, VALLEJO, CA 94590-2929
(707) 643-5785
(707) 643-8810
Mailing address
2290 SACRAMENTO ST, VALLEJO, CA 94590-2929
(707) 643-5785
(707) 643-8810
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
G58478
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
G58478
CA
207ND0900X
Dermatopathology Physician
G58478
CA
207NS0135X
Procedural Dermatology Physician
G58478
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0023150
—
CA
01
—
ZZZ97788Z
MEDICARE GROUP PTAN
CA
Enumeration date
06/03/2006
Last updated
10/12/2020
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