Provider Demographics
NPI:1194765495
Name:PARR, GREGORY ALAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:PARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5956
Mailing Address - Country:US
Mailing Address - Phone:386-673-5100
Mailing Address - Fax:386-673-6014
Practice Address - Street 1:300 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5956
Practice Address - Country:US
Practice Address - Phone:386-673-5100
Practice Address - Fax:386-673-6014
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060090208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20631Medicare UPIN
FL12420ZMedicare PIN