Individual
KEITH E GEORGESON
Active
Individual
KEITH E GEORGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
11841
AL
2086S0120X
Pediatric Surgery Physician
Primary
MD60183442
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014166
BLUE CROSS
AL
05
—
000014166
—
AL
01
—
00122960
MISSISSIPPI MEDICAID
MS
05
—
009946695
—
AL
05
—
009961775
—
AL
01
—
051520177
BLUE CROSS
AL
01
—
051523114
BLUE CROSS
AL
01
—
37862742A
GEORGIA MEDICAID
GA
01
—
A40463
HEALTHSPRING OF ALABAMA
AL
Enumeration date
06/16/2006
Last updated
03/28/2017
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