Provider Demographics
NPI:1104885573
Name:BARAN, GREGG A (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:BARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2330 UTAH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4817
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7000
Practice Address - Fax:850-416-7884
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME566672085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373893100Medicaid
AL118703Medicaid
FL300119793Medicare PIN
FL300119794Medicare PIN
FL300125454Medicare PIN
FL18890WMedicare PIN
FL373893100Medicaid
FL18890YMedicare PIN
FLP00446109Medicare PIN
FL18890UMedicare PIN
FL18890Medicare PIN
FL300119792Medicare PIN