Healthcare Provider Details

I. General information

NPI: 1508996513
Provider Name (Legal Business Name): DARRYL JORDAN GEBIEN MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GEORGIAN DR
BARRIE ONTARIO
L4M 6M2
CA

IV. Provider business mailing address

201 GEORGIAN DR APT
BARRIE ONTARIO
L4M 6M2
CA

V. Phone/Fax

Practice location:
  • Phone: 705-728-9090
  • Fax:
Mailing address:
  • Phone: 705-728-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 97534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: