Provider Demographics
NPI:1275520876
Name:CLOUD, GREG (PA - C)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:CLOUD
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Gender:M
Credentials:PA - C
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Mailing Address - Street 1:3716 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4355
Mailing Address - Country:US
Mailing Address - Phone:904-733-3529
Mailing Address - Fax:904-730-7687
Practice Address - Street 1:3716 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4355
Practice Address - Country:US
Practice Address - Phone:904-733-3529
Practice Address - Fax:904-730-7687
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant