Healthcare Provider Details

I. General information

NPI: 1659344489
Provider Name (Legal Business Name): GREGORY G SOLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14534 OLD SAINT AUGUSTINE RD STE 3220
JACKSONVILLE FL
32258-2645
US

IV. Provider business mailing address

PO BOX 44004
JACKSONVILLE FL
32231-4004
US

V. Phone/Fax

Practice location:
  • Phone: 904-880-1260
  • Fax: 904-880-1210
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-880-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME67747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME67747
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME67747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: