Provider Demographics
NPI:1144671710
Name:DUNGAN, GREGORY LOUIS JR (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LOUIS
Last Name:DUNGAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6600 MADISON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-1971
Mailing Address - Country:US
Mailing Address - Phone:727-815-7208
Mailing Address - Fax:727-266-4951
Practice Address - Street 1:6600 MADISON ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1971
Practice Address - Country:US
Practice Address - Phone:727-815-7208
Practice Address - Fax:727-266-4951
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14210207Q00000X, 208M00000X
FLUO4433207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025001200Medicaid