Healthcare Provider Details

I. General information

NPI: 1265473276
Provider Name (Legal Business Name): GARY R GEFFKEN PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARY ROY GEFFKEN

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/07/2017
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 TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3729
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: