Provider Demographics
NPI:1881682284
Name:FUNK, GREGORY S (DO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:S
Last Name:FUNK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547
Mailing Address - Country:US
Mailing Address - Phone:251-968-2441
Mailing Address - Fax:251-968-5555
Practice Address - Street 1:3849 GULF SHORES PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-968-2441
Practice Address - Fax:251-968-5555
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD058207Q00000X
ALDO58208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511 22924OtherBCBS
AL000010621Medicare ID - Type Unspecified
ALC78565Medicare UPIN