Provider Demographics
NPI:1902988637
Name:GREGORY, PAULA MARSH (DO)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARSH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:863-215-6639
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:13940 N US HIGHWAY 441 STE 102
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8909
Practice Address - Country:US
Practice Address - Phone:352-751-9900
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS7339OtherLICENSE
GAE96397Medicare UPIN
GA08CBCDDMedicare PIN