MEDICARE: DR. EUGENE JOSEPH RANKIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY 6386	FL

General Provider Information

NPI Number	:	1104870930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE JOSEPH RANKIN PH.D.

Provider Business Mailing Address
First Line	:	300 KINGSLEY LAKE DR
Second Line	:	STE 401
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3037
Country	:	US
Telephone Number	:	904-495-6800
Fax Number	:	904-281-0495

Provider Business Practice Location Address
First Line	:	300 KINGSLEY LAKE DR
Second Line	:	STE 401
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3037
Country	:	US
Telephone Number	:	904-495-6800
Fax Number	:	904-281-0495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/01/2016

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