Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS14210 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | UO4433 | FL |
NPI | 1144671710 |
---|---|
Provider Name | Dr. Gregory Louis Dungan JR. |
First Address | Clearwater, FL 33759-3012 |
Second Address | New Port Richey, FL 34652-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2016 |
Last Update Date | 26/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025001200 | (05) | FL |