Provider Demographics
NPI:1508967761
Name:LOMAS, GREGORY M (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:LOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 403, BLDG. B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-485-3351
Practice Address - Fax:941-485-7677
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-09-18
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Provider Licenses
StateLicense IDTaxonomies
CAG77161208800000X
FLME101239208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78528ZMedicaid
FL1632316323OtherUNIVERSAL HEALTHCARE
CA340007664OtherRAILROAD MEDICARE
FL344542OtherAVMED
CACP5241OtherRAILROAD MEDICARE GROUP
FLQMP000005225583OtherMOLINA HEALTHCARE
CA05D0617976OtherCLIA ID
FL1193368OtherWELLCARE
FLP00700437OtherR.R. MEDICARE
CA00G771610Medicare PIN
CA340007664OtherRAILROAD MEDICARE
FLQMP000005225583OtherMOLINA HEALTHCARE
FLAK671ZMedicare PIN