Provider Demographics
NPI:1952590218
Name:GRETZULA, JOSEPH C (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:GRETZULA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NE 6TH ST SUITE 106
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4168
Mailing Address - Country:US
Mailing Address - Phone:561-736-8514
Mailing Address - Fax:561-736-8587
Practice Address - Street 1:100 NE 6TH ST SUITE 106
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4168
Practice Address - Country:US
Practice Address - Phone:561-736-8514
Practice Address - Fax:561-736-8587
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5031207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82951Medicare PIN
FLE14532Medicare UPIN