Provider Demographics
NPI:1255309928
Name:BOGER, GREGORY NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:NEIL
Last Name:BOGER
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 1:2828 CASA ALOMA WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2272
Mailing Address - Country:US
Mailing Address - Phone:407-937-1031
Mailing Address - Fax:407-678-0627
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2223
Practice Address - Country:US
Practice Address - Phone:407-937-1031
Practice Address - Fax:407-678-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83581207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH52846Medicare UPIN
FL05303Medicare ID - Type Unspecified
FL262823600Medicare ID - Type Unspecified