Provider Demographics
NPI:1396757118
Name:GREGORY, ANTHONY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12321 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3552
Mailing Address - Country:US
Mailing Address - Phone:352-332-6221
Mailing Address - Fax:
Practice Address - Street 1:4131 NW 13TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-4151
Practice Address - Country:US
Practice Address - Phone:352-376-1887
Practice Address - Fax:352-375-7451
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040070207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067340400Medicaid
FL01318OtherBCBS
FL050035222OtherRR MEDICARE
FL01318XMedicare ID - Type Unspecified
FL067340400Medicaid