Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OS8594 | FL |
N | 207NS0135X | Procedural Dermatology | OS8594 | FL |
NPI | 1487625885 |
---|---|
Provider Name | Gregory M Houck |
First Address | Estero, FL 33928-9459 |
Second Address | Estero, FL 33928-9459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 10/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34385 | (02) |