| Gregory A. Cisneros MD PA | |
|
33 Old Kings Rd N Suite 2 Palm Coast FL 32137-8227 | |
| (386) 263-2718 | |
| Not Available |
| Full Name | Gregory A. Cisneros MD PA |
|---|---|
| Speciality | Family Medicine |
| Location | 33 Old Kings Rd N, Palm Coast, Florida |
| Authorized Official Name and Position | Gregorio a Cisneros (OWNER) |
| Authorized Official Contact | 3862632718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory A. Cisneros MD PA 33 Old Kings Rd N Suite 2 Palm Coast FL 32137-8227 Ph: (386) 263-2718 | Gregory A. Cisneros MD PA 33 Old Kings Rd N Suite 2 Palm Coast FL 32137-8227 Ph: (386) 263-2718 |
| NPI Number | 1821242157 |
|---|---|
| Provider Enumeration Date | 11/13/2008 |
| Last Update Date | 11/13/2008 |
| Medicare PECOS PAC ID | 8527118074 |
|---|---|
| Medicare Enrollment ID | O20090604000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821242157 | NPI | - | NPPES |
| ME84611 | Other | FL | OWNER STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME84611 (Florida) | Primary |
| Provider Name | Gregorio a Cisneros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801893854 PECOS PAC ID: 4385748102 Enrollment ID: I20070403000431 |
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