Organization
CORAL REEF RADIOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL GREGG M.D. (REGISTERED AGENT)
(772) 621-3059
Entity
Organization
Contact information
Practice address
9333 SW 152ND ST, VILLAGE OF PALMETTO BAY, FL 33157-1778
(772) 621-3000
(772) 621-3181
Mailing address
900 E PRIMA VISTA BLVD, SUITE 200, PORT ST LUCIE, FL 34952-2366
(772) 621-3000
(772) 621-3181
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062960000
—
FL
Enumeration date
09/20/2006
Last updated
07/29/2008
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