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General NPI Number Information
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NPI Number | 1174539860
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Entity Type | Individual
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Provider Name | GREGORIO NUNEZ MEDALLE MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 1052 DOWNING CIRCLE
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City | WAUCHULA
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State | FL
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Zip | 33873
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Country | US
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Telephone | 863-773-3773
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Fax | 863-773-0358
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Provider Business Mailing Address
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Address Line | 1052 DOWNING CIRCLE
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City | WAUCHULA
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State | FL
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Zip | 33873
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Country | US
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Telephone | 863-773-3773
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Fax | 863-773-0358
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME44016
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME0044016
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License Number State | FL
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