Basic Information
Provider Information | |||||||||
NPI: | 1285620559 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GEE | ||||||||
FirstName: | JEFFRY | ||||||||
MiddleName: | TRAVIS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 118 12TH STREET | ||||||||
Address2: |   | ||||||||
City: | PRINCETON | ||||||||
State: | WV | ||||||||
PostalCode: | 247402352 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044315153 | ||||||||
FaxNumber: | 3044877835 | ||||||||
Practice Location | |||||||||
Address1: | 1333 SOUTHVIEW DRIVE | ||||||||
Address2: |   | ||||||||
City: | BLUEFIELD | ||||||||
State: | WV | ||||||||
PostalCode: | 247014317 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3043279205 | ||||||||
FaxNumber: | 3043279210 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/22/2005 | ||||||||
LastUpdateDate: | 02/02/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101225082 | VA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 23903 | WV | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | P01414652 | 01 | VA | RAILROAD MEDICARE | OTHER | 216749 | 01 |   | BCBS | OTHER | 004945522 | 05 | VA |   | MEDICAID | 260609000 | 01 | VA | MAGELLAN | OTHER | 3810017518 | 05 | WV |   | MEDICAID | 1285620559 | 05 | VA |   | MEDICAID |