Provider Demographics
NPI:1700014974
Name:DURST, GREGORY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBERT
Last Name:DURST
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 1:1601 SW ARCHER RD
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-374-6064
Mailing Address - Fax:352-379-4180
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-374-6064
Practice Address - Fax:352-379-4180
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8642207R00000X
FLTRN149512085R0202X
IA406572085R0202X
FLME 1204042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine