Provider Demographics
NPI:1396813937
Name:JON F GEFFEN DO PC
Entity Type:Organization
Organization Name:JON F GEFFEN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-572-2663
Mailing Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3933
Mailing Address - Country:US
Mailing Address - Phone:253-572-2663
Mailing Address - Fax:
Practice Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3933
Practice Address - Country:US
Practice Address - Phone:253-572-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001971208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195192OtherWA STATE LABOR & INDUST
WA1121672Medicaid
G8854013Medicare PIN
WA0195192OtherWA STATE LABOR & INDUST