Provider Demographics
NPI:1639162522
Name:TOMLINSON, GREGORY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHARLES
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8773 PERIMETER PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1165
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:7807 BAYMEADOWS RD E
Practice Address - Street 2:STE 209
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9664
Practice Address - Country:US
Practice Address - Phone:904-330-1024
Practice Address - Fax:904-330-1027
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86960207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0103467-00OtherFL MEDICAID - GROUP
FLHR822AOtherFL MEDICARE - GROUP
FL004XPOtherFLORIDA BLUE - GROUP
FL10786680OtherCIGNA
P00030751OtherRAILROAD
FL0015008-00Medicaid
GA003119716AOtherGEORGIA MEDICAID - INDIVIDUAL
FL295965OtherAVMED
FL0015008-00Medicaid
P00030751OtherRAILROAD