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NPI Code Detail

MEDICARE: ROGER GREF CAP

MEDICARE: ROGER GREF CAP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCAP1741FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639188485
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER GREF CAP
Provider Business Mailing Address
First Line : 3292 COUNTY ROAD 220
Second Line :
City : MIDDLEBURG
State : FL
Zip : 32068-4357
Country : US
Telephone Number : 904-291-5561
Fax Number : 904-291-5575
Provider Business Practice Location Address
First Line : 3292 COUNTY ROAD 220
Second Line :
City : MIDDLEBURG
State : FL
Zip : 32068-4357
Country : US
Telephone Number : 904-291-5561
Fax Number : 904-291-5575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 07/09/2007

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Directions to “ ROGER GREF CAP” Practice Location

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