Provider Demographics
NPI:1104870930
Name:RANKIN, EUGENE JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOSEPH
Last Name:RANKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KINGSLEY LAKE DR
Mailing Address - Street 2:STE 401
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3037
Mailing Address - Country:US
Mailing Address - Phone:904-495-6800
Mailing Address - Fax:904-281-0495
Practice Address - Street 1:300 KINGSLEY LAKE DR
Practice Address - Street 2:STE 401
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3037
Practice Address - Country:US
Practice Address - Phone:904-495-6800
Practice Address - Fax:904-281-0495
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6386103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73662AMedicare ID - Type UnspecifiedPROVIDER NUMBER