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Individual

WALLACE GRANT GEIGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 223-6600
Mailing address
1100 OLIVE WAY, MS M4-PA, SEATTLE, WA 98101-1873
(206) 515-5811
(206) 515-5886

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10003886
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0039591
LABOR AND INDUSTRIES#
WA
01
5575GE
BLUE SHIELD #
WA
05
8393456
WA
Enumeration date
01/30/2007
Last updated
04/10/2008
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