Provider Demographics
NPI:1467886408
Name:CHARDON, GREGORY ULYSSES JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ULYSSES
Last Name:CHARDON
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1700 SE HILLMOOR DR STE 500
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7536
Mailing Address - Country:US
Mailing Address - Phone:772-335-3200
Mailing Address - Fax:877-406-5592
Practice Address - Street 1:1700 SE HILLMOOR DR STE 500
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7536
Practice Address - Country:US
Practice Address - Phone:772-335-3200
Practice Address - Fax:877-406-5592
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-10-08
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant