Healthcare Provider Details

I. General information

NPI: 1487625885
Provider Name (Legal Business Name): GREGORY M HOUCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/10/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 ARCOS AVE STE 201
ESTERO FL
33928-3529
US

IV. Provider business mailing address

10200 ARCOS AVE STE 201
ESTERO FL
33928-3529
US

V. Phone/Fax

Practice location:
  • Phone: 239-390-3376
  • Fax: 239-333-0474
Mailing address:
  • Phone: 239-390-3376
  • Fax: 239-333-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberOS8594
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS8594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: