Provider Demographics
NPI:1093993701
Name:EUGENE J. RANKIN, PH.D., ABPP, P.L
Entity Type:Organization
Organization Name:EUGENE J. RANKIN, PH.D., ABPP, P.L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-281-0493
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:STE 803
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-281-0493
Mailing Address - Fax:904-281-0495
Practice Address - Street 1:6817 SOUTHPOINT PKWY
Practice Address - Street 2:STE 803
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6282
Practice Address - Country:US
Practice Address - Phone:904-281-0493
Practice Address - Fax:904-281-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6386261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73662AMedicare PIN