Gregory Brent Archer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1039420 Issued in FL

Practice address

550-A Twin Cities Boulevard
Orthopaedic and Spine Surgery Center
Niceville, FL 32578

Phone

(850) 729-1444

NPI assigned

Dec 4, 2006

Last updated

Jan 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kapil Puri MD P a

  • Urology Physician
  • Niceville, FL
  • NPI 1962672337
  NPD (past)
• Mark S. Calkins, MD, PA.

  • Orthopaedic Surgery Physician
  • Niceville, FL
  • NPI 1922031509
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295222400000",
    "number": "1114085115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550-A TWIN CITIES BOULEVARD",
            "address_2": "ORTHOPAEDIC AND SPINE SURGERY CENTER",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-729-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550-A TWIN CITIES BOULEVARD",
            "address_2": "ORTHOPAEDIC AND SPINE SURGERY CENTER",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "32578",
            "telephone_number": "850-729-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHER",
        "first_name": "GREGORY",
        "middle_name": "BRENT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2011-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "1039420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "EE914Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUE SHIELD PROVIDER NUMBER",
            "identifier": "Y05UU",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Dobler Counseling, LLC
• An Instrument of Healing and Peace
• Eamon Anderson
• Olivia Andrews
• Cinderella B Aquino, M.D.
• Julie Anne Augustine, PA-C
• Koralis Mary Ayala Lopez
• Laura Ayotte
• Gabrielle Aziz, RDN, LDN, CHES, CHC
• Ashley Babler

• Physician Assistant in Niceville, FL
• Providers in Niceville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.