Healthcare Provider Details

I. General information

NPI: 1104885573
Provider Name (Legal Business Name): GREGG A BARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7000
  • Fax: 850-416-7884
Mailing address:
  • Phone: 813-251-5822
  • Fax: 813-254-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME56667
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME56667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: