Provider Demographics
NPI:1528377827
Name:EUGENE E GREGUSH MD PA
Entity Type:Organization
Organization Name:EUGENE E GREGUSH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREGUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-624-3500
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:STE 201A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5338
Mailing Address - Country:US
Mailing Address - Phone:941-624-3500
Mailing Address - Fax:941-625-6977
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:STE 201A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5338
Practice Address - Country:US
Practice Address - Phone:941-624-3500
Practice Address - Fax:941-625-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME41486OtherSTATE LICENSE NUMBER