Provider Demographics
NPI:1164571709
Name:GREGG, PHILLIP MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:GREGG
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1003 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE#101
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3601
Mailing Address - Country:US
Mailing Address - Phone:239-574-4600
Mailing Address - Fax:239-574-2621
Practice Address - Street 1:1003 DEL PRADO BLVD S
Practice Address - Street 2:SUITE#101
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3601
Practice Address - Country:US
Practice Address - Phone:239-574-4600
Practice Address - Fax:239-574-2621
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-08-14
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Provider Licenses
StateLicense IDTaxonomies
FLPA2649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant