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General NPI Number Information
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NPI Number | 1396812871
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Entity Type | Organization
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Legal Business Name | C GREVENGOOD MD PA
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11181 HEALTH PARK BLVD SUITE 1000
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City | NAPLES
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State | FL
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Zip | 34110-5738
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Country | US
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Telephone | 239-514-3131
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Fax | 239-597-5683
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Provider Business Mailing Address
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Address Line | 11181 HEALTH PARK BLVD SUITE 1000
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City | NAPLES
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State | FL
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Zip | 34110-5738
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Country | US
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Telephone | 239-514-3131
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Fax | 239-597-5683
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS GREVENGOOD
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Credential | MD
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Telephone | 239-514-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME0067027
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License Number State | FL
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