Provider Demographics
NPI:1497075352
Name:SCHOTT, GREGORY RAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RAY
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PINE FOREST DRIVE, N.
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-514-1687
Mailing Address - Fax:904-215-8299
Practice Address - Street 1:836 PRUDENTIAL DRIVE
Practice Address - Street 2:STE 1601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32007
Practice Address - Country:US
Practice Address - Phone:904-396-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1650FLORIDA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant