Individual
KEITH E GEORGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 W 8TH AVE, SUITE 100 L-1, SPOKANE, WA 99204-2307
(509) 474-5445
(509) 227-7070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 227-7070
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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