Healthcare Provider Details

I. General information

NPI: 1205908340
Provider Name (Legal Business Name): JON FERRELL GEFFEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3933
US

IV. Provider business mailing address

1515 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3933
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-2663
  • Fax:
Mailing address:
  • Phone: 253-572-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP00001971
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: