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NPI Code Detail

MEDICARE: GREGORY L NEDURIAN M.D.

MEDICARE: GREGORY L NEDURIAN M.D.
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
1208600000XSurgery PhysicianME0090819FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417942681
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY L NEDURIAN M.D.
Provider Business Mailing Address
First Line : 521 BUENA VISTA ST
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4504
Country : US
Telephone Number : 863-687-0550
Fax Number : 863-682-7700
Provider Business Practice Location Address
First Line : 521 BUENA VISTA ST
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4504
Country : US
Telephone Number : 863-687-0550
Fax Number : 863-682-7700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 07/08/2007

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