Provider Demographics
NPI:1124246855
Name:GEITZ, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4145
Mailing Address - Country:US
Mailing Address - Phone:785-452-7269
Mailing Address - Fax:785-452-6008
Practice Address - Street 1:511 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4145
Practice Address - Country:US
Practice Address - Phone:785-452-4860
Practice Address - Fax:785-452-4878
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32987207RH0003X, 207RH0003X
MO0432987207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613380CMedicaid
KS110116092Medicare PIN