Gregorio Nunez Medalle, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME44016 Issued in FL

Practice address

1052 Downing Circle
Wauchula, FL 33873

Phone

(863) 773-3773

Fax

(863) 773-0358

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• K Wade Foster MD PA

  dba Florida Dermatology & Skin Cancer Centers

  • MOHS-Micrographic Surgery Physician
  • Winter Haven, FL
  • NPI 1205066404
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1174539860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 DOWNING CIRCLE",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "33873",
            "telephone_number": "863-773-3773",
            "fax_number": "863-773-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 DOWNING CIRCLE",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "33873",
            "telephone_number": "863-773-3773",
            "fax_number": "863-773-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDALLE",
        "first_name": "GREGORIO",
        "middle_name": "NUNEZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME44016",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME0044016",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068576300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Varghese E Mathai, MD
• Lucy Jayne Matos, L.M.T
• Karen E McKenzie, DMD
• MCR Health, Inc. (Ama Wauchula)
• MCR Health, Inc.
• Christy A Merrick, ARNP
• Adna Metayer
• Miles S Judah, Inc (Pete's Pharmacy)
• Bonnie Misiak, DDS
• Kayum Mohammadbhoy, M.D.

• Surgery Physician in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; 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.