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General NPI Number Information
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NPI Number | 1881682284
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Entity Type | Individual
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Provider Name | GREGORY S FUNK D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 3849 GULF SHORES PKWY SUITE 9
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City | GULF SHORES
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State | AL
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Zip | 36542
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Country | US
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Telephone | 251-968-2441
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Fax | 251-968-5555
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Provider Business Mailing Address
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Address Line | PO BOX 2029
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City | GULF SHORES
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State | AL
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Zip | 36547
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Country | US
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Telephone | 251-968-2441
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Fax | 251-968-5555
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D058
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License Number State | AL
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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 | DO58
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License Number State | AL
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