Provider Demographics
NPI:1760625099
Name:GREGORY W. NESTOR, MD, LLC
Entity Type:Organization
Organization Name:GREGORY W. NESTOR, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-547-0825
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46776207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03655AMedicare PIN