Provider Demographics
NPI:1912173725
Name:GRECO, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:GRECO
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 1:1333 3RD AVE S STE 402
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6535
Mailing Address - Country:US
Mailing Address - Phone:239-352-5600
Mailing Address - Fax:239-353-8900
Practice Address - Street 1:1333 3RD AVE S STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6499
Practice Address - Country:US
Practice Address - Phone:239-352-5600
Practice Address - Fax:239-353-8900
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0980207R00000X
IAMD-40387207R00000X, 208M00000X
FLME147717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141603Medicare PIN