Provider Demographics
NPI:1053429779
Name:GEISTLER, PERRY KENT (DPM)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:KENT
Last Name:GEISTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12152 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1779
Mailing Address - Country:US
Mailing Address - Phone:314-849-7600
Mailing Address - Fax:314-842-0106
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1779
Practice Address - Country:US
Practice Address - Phone:314-849-7600
Practice Address - Fax:314-842-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000612213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU30241Medicare UPIN
MO5820380001Medicare NSC