Active NPI
Mark Gregory
- Surgical Technologist
- South Daytona, FL
National Provider Identifier
1275980153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 816376
- Practice address
- 1718 Western Rd
South Daytona, FL 32119-1932 - Phone
- (386) 295-3159
- NPI assigned
- May 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 816376 | FL | Primary |
Addresses
Primary practice location
1718 Western Rd
South Daytona, FL 32119-1932
Mailing address
1718 Western Rd
South Daytona, FL 32119-1932
Phone (386) 295-3159
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 816376 | FL | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463616000000",
"number": "1275980153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1718 WESTERN RD",
"city": "SOUTH DAYTONA",
"state": "FL",
"postal_code": "321191932",
"telephone_number": "386-295-3159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1718 WESTERN RD",
"city": "SOUTH DAYTONA",
"state": "FL",
"postal_code": "321191932",
"telephone_number": "386-295-3159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREGORY",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-19",
"last_updated": "2016-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "FL",
"license": "816376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Daytona, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.