Provider Demographics
NPI:1487625885
Name:HOUCK, GREGORY M (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:HOUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 ARCOS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3529
Mailing Address - Country:US
Mailing Address - Phone:239-390-3376
Mailing Address - Fax:239-333-0474
Practice Address - Street 1:10200 ARCOS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3529
Practice Address - Country:US
Practice Address - Phone:239-390-3376
Practice Address - Fax:239-333-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8594207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0264Medicare PIN
I34385Medicare UPIN