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General NPI Number Information
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NPI Number | 1396887832
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Entity Type | Organization
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Legal Business Name | GREGORY J SENGSTOCK MD PA
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 14546 SAINT AUGUSTINE RD SUITE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5468
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Country | US
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Telephone | 904-292-4049
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Fax | 904-292-4805
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Provider Business Mailing Address
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Address Line | 14546 OLD SAINT AUGUSTINE RD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5468
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Country | US
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Telephone | 904-292-4049
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Fax | 904-292-4805
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GREGORY SENGSTOCK
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Credential | MD,PHD
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Telephone | 904-292-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME81447
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License Number State | FL
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