Provider Demographics
NPI:1023013661
Name:GREDLER, FRANK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:EDWARD
Last Name:GREDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-216-0191
Practice Address - Street 1:1300 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-216-0191
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54304207RC0000X
GA042836207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000659062AMedicaid
FL04619OtherBLUE CROSS BLUE SHIELD
FL049104700Medicaid
FL01106OtherUNIVERSAL HEALTH CARE
AL009979020Medicaid
GA00000OtherBLUE CROSS BLUE SHIELD
AL009979020Medicaid
FL049104700Medicaid
FL01106OtherUNIVERSAL HEALTH CARE