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Individual

GREGORY MINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1615 PASADENA AVE S STE 200, SOUTH PASADENA, FL 33707-4518
(813) 978-9700
(813) 558-6185
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6185

Taxonomy

Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME141695
FL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/12/2018
Last updated
07/26/2022
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