Provider Demographics
NPI:1194725374
Name:GEISSLER, WILLIAM BENNETT (MD)
Entity type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:BENNETT
Last Name:GEISSLER
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5144
Mailing Address - Fax:601-815-3027
Practice Address - Street 1:1410 E WOODROW WILSON AVE
Practice Address - Street 2:STE D
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5114
Practice Address - Country:US
Practice Address - Phone:601-984-5144
Practice Address - Fax:601-815-3027
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11169207XS0106X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00462205OtherRAILROAD MEDICARE PTAN
MS00116304Medicaid
AL126102Medicaid
MS512I200005OtherMEDICARE PTAN
11169OtherLICENSE
LA1990728Medicaid
200014928OtherRAILROAD MEDICARE
MS302I205894Medicare PIN
AL126102Medicaid
MSP01118798Medicare PIN