Provider Demographics
NPI:1154551398
Name:PAVLAT, GREGORY G (M D)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:PAVLAT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 FITCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4507
Mailing Address - Country:US
Mailing Address - Phone:904-438-5503
Mailing Address - Fax:
Practice Address - Street 1:11912 FITCHWOOD CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-4507
Practice Address - Country:US
Practice Address - Phone:904-438-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine