Healthcare Provider Details

I. General information

NPI: 1104372986
Provider Name (Legal Business Name): GEFFKEN GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 NW 41ST ST UNIT 140
GAINESVILLE FL
32606-6986
US

IV. Provider business mailing address

2833 NW 41ST ST UNIT 140
GAINESVILLE FL
32606-6986
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-1426
  • Fax: 352-376-5781
Mailing address:
  • Phone: 352-377-1426
  • Fax: 352-376-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3729
License Number StateFL

VIII. Authorized Official

Name: DR. GARY R GEFFKEN
Title or Position: CHIEF
Credential: PHD
Phone: 352-377-1426