MEDICARE: DR. JOSEPH C GRETZULA DO

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	:	1952590218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH C GRETZULA DO

Provider Business Mailing Address
First Line	:	100 NE 6TH ST SUITE 106
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4168
Country	:	US
Telephone Number	:	561-736-8514
Fax Number	:	561-736-8587

Provider Business Practice Location Address
First Line	:	100 NE 6TH ST SUITE 106
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4168
Country	:	US
Telephone Number	:	561-736-8514
Fax Number	:	561-736-8587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	02/10/2022

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