Healthcare Provider Details

I. General information

NPI: 1902988637
Provider Name (Legal Business Name): PAULA MARSH GREGORY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13940 N US HIGHWAY 441 STE 102
LADY LAKE FL
32159-8909
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-9900
  • Fax: 844-388-6186
Mailing address:
  • Phone: 863-215-6639
  • Fax: 844-388-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: