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General NPI Number Information
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NPI Number | 1063498723
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Entity Type | Individual
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Provider Name | GREGORY JAMES PIACENTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 1106 HOSPITAL ROAD NEUROLOGY DEPARTMENT
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-863-8253
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Fax | 850-863-7045
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Provider Business Mailing Address
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Address Line | 1106 HOSPITAL ROAD NEUROSCIENCE CENTER
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-863-8253
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Fax | 850-863-7045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME63890
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License Number State | FL
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