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NPI Code Detail

MEDICARE: GREGORY PAUL STAVISKI M.D.

MEDICARE: GREGORY PAUL STAVISKI 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
1174400000XSpecialistME63238FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17290008OTHERFLAETNA
244880OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1619934379
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY PAUL STAVISKI M.D.
Provider Business Mailing Address
First Line : PO BOX 699
Second Line :
City : GULF BREEZE
State : FL
Zip : 32562-0699
Country : US
Telephone Number : 850-243-7788
Fax Number : 850-243-7738
Provider Business Practice Location Address
First Line : 151 MARY ESTHER BLVD
Second Line : SUITE 303
City : MARY ESTHER
State : FL
Zip : 32569-1972
Country : US
Telephone Number : 850-243-7788
Fax Number : 850-243-7738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 07/08/2007

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