Individual
GEOFFREY LAKE RISLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5149 N 9TH AVE STE 120, PENSACOLA, FL 32504-8734
(850) 479-1805
(850) 479-1829
Mailing address
PO BOX 11982, PENSACOLA, FL 32524-1982
(850) 479-1805
(850) 479-9182
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME83348
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263422800
—
FL
01
—
P00023613
MEDICARE RAILROAD
—
Enumeration date
06/01/2005
Last updated
03/31/2025
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