Provider Demographics
NPI:1871540062
Name:LISTOE, GREGORY B (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:LISTOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOODLETTE RD N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5400
Mailing Address - Country:US
Mailing Address - Phone:239-593-3881
Mailing Address - Fax:
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:SUITE 310
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-593-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-09-12
Deactivation Date:2012-11-20
Deactivation Code:
Reactivation Date:2014-09-12
Provider Licenses
StateLicense IDTaxonomies
FLME80415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262451600Medicaid
FL262451600Medicaid