Individual
GREGORY BRENT ARCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550-A TWIN CITIES BOULEVARD, ORTHOPAEDIC AND SPINE SURGERY CENTER, NICEVILLE, FL 32578
(850) 729-1444
Mailing address
550-A TWIN CITIES BOULEVARD, ORTHOPAEDIC AND SPINE SURGERY CENTER, NICEVILLE, FL 32578
(850) 729-1444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1039420
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EE914Z
MEDICARE PTAN
FL
01
—
Y05UU
BLUECROSSBLUE SHIELD PROVIDER NUMBER
FL
Enumeration date
12/04/2006
Last updated
01/17/2011
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