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General NPI Number Information
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NPI Number | 1568091197
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Entity Type | Individual
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Provider Name | SHANE THOMAS GEFFE MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 2780 CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-5858
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Country | US
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Telephone | 239-343-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 5862 MUSKET LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-1707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME152216
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 96067
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License Number State | GA
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