MEDICARE: JOSEPH C GRETZULA DO FAAD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	OS5031	FL

General Provider Information

NPI Number	:	1033102801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH C GRETZULA DO FAAD PA

Provider Business Mailing Address
First Line	:	100 NE 6TH ST UNIT 201
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4162
Country	:	US
Telephone Number	:	561-736-8514
Fax Number	:	561-736-8587

Provider Business Practice Location Address
First Line	:	555 N CONGRESS AVE
Second Line	:	SUITE 201
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3320
Country	:	US
Telephone Number	:	561-736-8514
Fax Number	:	561-736-8587

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH C GRETZULA
Credential	:	DO
Telephone Number	:	561-736-8514

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/08/2022

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