Provider Demographics
NPI:1639165863
Name:NESTOR, GREGORY W (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:NESTOR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7655 38TH AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1263
Mailing Address - Country:US
Mailing Address - Phone:727-547-0825
Mailing Address - Fax:727-547-0523
Practice Address - Street 1:7655 38TH AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1263
Practice Address - Country:US
Practice Address - Phone:727-547-0825
Practice Address - Fax:727-547-0523
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME46776207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062643100Medicaid
FL062643100Medicaid