Individual
MR. GREGORY FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
918 NW 120TH ST, GAINESVILLE, FL 32606-0438
(352) 359-5162
Mailing address
PO BOX 100186, GAINESVILLE, FL 32610-0186
(352) 265-5911
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015332300
—
FL
Enumeration date
06/24/2015
Last updated
09/08/2015
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