Individual
MR. GEOFFREY GEORGE GEPHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
10012 AUBURN PARK DR, FORT WAYNE, IN 46825-2389
(317) 644-8457
Mailing address
1731 SYCAMORE HILLS DR, FORT WAYNE, IN 46814-9390
(260) 625-3693
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28185645A
IN
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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