Provider Demographics
NPI:1407872062
Name:NEIMEYER, GREGORY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:NEIMEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:JAMES
Other - Last Name:NEIMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-0601
Mailing Address - Fax:352-392-4549
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0371
Practice Address - Country:US
Practice Address - Phone:352-955-6531
Practice Address - Fax:352-392-4549
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55291Medicare UPIN
FL75996YMedicare PIN
FL75996Medicare ID - Type Unspecified