Provider Demographics
NPI:1922133438
Name:PHARMPHYS PC
Entity Type:Organization
Organization Name:PHARMPHYS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-414-0595
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306-0274
Mailing Address - Country:US
Mailing Address - Phone:757-414-0595
Mailing Address - Fax:757-414-0596
Practice Address - Street 1:15249 ARTHURS COURT
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-414-0595
Practice Address - Fax:757-414-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA239522OtherBLUE SHIELD GROUP
VA239523OtherBLUE CROSS
VA239522OtherBLUE CROSS
VA10393731OtherCAQH
VA239523OtherBLUE SHIELD
VA239523OtherBLUE SHIELD
VA239522OtherBLUE CROSS
VA10393731OtherCAQH
VA239523OtherBLUE CROSS