Provider Demographics
NPI:1265473276
Name:GEFFKEN, GARY R (PH D)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:GEFFKEN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:ROY
Other - Last Name:GEFFKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2833 NW 41ST ST
Mailing Address - Street 2:UNIT 140
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6986
Mailing Address - Country:US
Mailing Address - Phone:352-377-1426
Mailing Address - Fax:352-376-5781
Practice Address - Street 1:2833 NW 41ST ST
Practice Address - Street 2:UNIT 140
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6986
Practice Address - Country:US
Practice Address - Phone:352-377-1426
Practice Address - Fax:352-376-5781
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3729103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042063800Medicaid
FL74469XMedicare PIN
74469ZMedicare UPIN
FL042063800Medicaid