Provider Demographics
NPI:1225264096
Name:BEAULIEU, GREGORY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:BEAULIEU
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 1:4351 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3106
Mailing Address - Country:US
Mailing Address - Phone:239-263-1777
Mailing Address - Fax:
Practice Address - Street 1:4351 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3106
Practice Address - Country:US
Practice Address - Phone:293-263-1777
Practice Address - Fax:239-263-6983
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123635207ZP0102X, 207ZB0001X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL36525OtherMEDICAL LICENSE
DCMD039336OtherMEDICAL LICENSE
FL014812400Medicaid
FLME123635OtherMEDICAL LICENSE
FLME123635OtherMEDICAL LICENSE
FLIE989ZMedicare PIN