Organization
FLORIDA PRACTITIONERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TOBIAS GRAY PA-C (CEO)
(954) 791-6146
Entity
Organization
Contact information
Practice address
1995 E OAKLAND PARK BLVD STE 250, FT LAUDERDALE, FL 33306-1149
(615) 657-4805
(954) 337-2733
Mailing address
PO BOX 936535, ATLANTA, GA 31193-6535
(954) 791-6146
(954) 337-2733
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3649
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020654300
—
FL
Enumeration date
12/29/2014
Last updated
06/23/2020
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