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General NPI Number Information
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NPI Number | 1306194873
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Entity Type | Organization
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Legal Business Name | PRECISION TELERADIOLOGY LLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8101 GLENFINNAN CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4013
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Country | US
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Telephone | 239-980-4664
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Fax | 866-269-2214
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Provider Business Mailing Address
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Address Line | 8101 GLENFINNAN CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4013
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Country | US
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Telephone | 239-980-4664
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Fax | 866-269-2214
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR HARLEY GREGORY
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Credential | D.O.
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Telephone | 239-980-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | L09000051092
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License Number State | FL
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