Provider Demographics
NPI:1215151451
Name:GREGORY M DOWBAK MD PA
Entity type:Organization
Organization Name:GREGORY M DOWBAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOWBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-498-4910
Mailing Address - Street 1:285 GRANDE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-6424
Mailing Address - Country:US
Mailing Address - Phone:239-218-3428
Mailing Address - Fax:
Practice Address - Street 1:27399 RIVERVIEW CENTER BLVD
Practice Address - Street 2:101
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4303
Practice Address - Country:US
Practice Address - Phone:239-498-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43416302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0075104OtherMEDICAL LICENSE
FLME0075104OtherMEDICAL LICENSE