MEDICARE: EUGENE J. RANKIN, PH.D., ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PY6386	FL

General Provider Information

NPI Number	:	1942611421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE J. RANKIN, PH.D., ABPP

Provider Business Mailing Address
First Line	:	300 KINGSLEY LAKE DR
Second Line	:	SUITE 403
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3037
Country	:	US
Telephone Number	:	904-281-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 KINGSLEY LAKE DR
Second Line	:	SUITE 403
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3037
Country	:	US
Telephone Number	:	904-281-0493
Fax Number	:

Authorized Official
Title or Position	:	PH.D.
Name	:	DR. EUGENE RANKIN
Credential	:	PH.D.
Telephone Number	:	904-281-0493

Provider Enumeration Date	:	05/18/2014
Last Update Date	:	05/18/2014

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