Provider Demographics
NPI:1063498723
Name:PIACENTE, GREGORY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:PIACENTE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1106 HOSPITAL ROAD
Mailing Address - Street 2:NEUROSCIENCE CENTER
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8253
Mailing Address - Fax:850-863-7045
Practice Address - Street 1:1106 HOSPITAL ROAD
Practice Address - Street 2:NEUROLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8253
Practice Address - Fax:850-863-7045
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME638902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372892700Medicaid
FL18816OtherBCBSFL
FL372892700Medicaid
FL18816OtherBCBSFL