1508996513 NPI number — DR. DARRYL JORDAN GEBIEN MD, MSC

Table of content: DR. DARRYL JORDAN GEBIEN MD, MSC (NPI 1508996513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508996513 NPI number — DR. DARRYL JORDAN GEBIEN MD, MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEBIEN
Provider First Name:
DARRYL
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MSC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508996513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 GEORGIAN DR
Provider Second Line Business Mailing Address:
APT
Provider Business Mailing Address City Name:
BARRIE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L4M 6M2
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
705-728-9090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GEORGIAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRIE
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
L4M 6M2
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
705-728-9090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME 97534 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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