Provider Demographics
NPI:1871669069
Name:ALBERT, GREGORY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
Last Name:ALBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N MILITARY TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6300
Mailing Address - Country:US
Mailing Address - Phone:561-495-2700
Mailing Address - Fax:561-495-5826
Practice Address - Street 1:3010 N MILITARY TRL STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6300
Practice Address - Country:US
Practice Address - Phone:561-495-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49835Medicare ID - Type Unspecified
FLH11795Medicare UPIN