Provider Demographics
NPI:1790775286
Name:GREGG, RALPH (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:GREGG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:851 TRAFALGAR CT
Mailing Address - Street 2:STE 200E
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7420
Mailing Address - Country:US
Mailing Address - Phone:407-667-0444
Mailing Address - Fax:407-667-4338
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9322
Practice Address - Country:US
Practice Address - Phone:239-332-5344
Practice Address - Fax:239-332-7246
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-01-09
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Provider Licenses
StateLicense IDTaxonomies
FLME0058967207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050028812OtherMCRR
FL0867335OtherCIGNA
FL11737OtherBSFL
FL790501OtherAETNA
FL052607000Medicaid
FL11737ZOtherMCR