MEDICARE: DR. GARY R GEFFKEN 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	103T00000X	Psychologist	PY3729	FL
2	103TC0700X	Clinical Psychologist	PY3729	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265473276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY R GEFFKEN PH D

Provider Business Mailing Address
First Line	:	2833 NW 41ST ST
Second Line	:	UNIT 140
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6986
Country	:	US
Telephone Number	:	352-377-1426
Fax Number	:	352-376-5781

Provider Business Practice Location Address
First Line	:	2833 NW 41ST ST
Second Line	:	UNIT 140
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6986
Country	:	US
Telephone Number	:	352-377-1426
Fax Number	:	352-376-5781

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/07/2017

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