Provider Demographics
NPI:1588915011
Name:GREGORY L DOKKA DC PA
Entity type:Organization
Organization Name:GREGORY L DOKKA DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOKKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-447-4255
Mailing Address - Street 1:51 SOUTH MAIN AVENUE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3934
Mailing Address - Country:US
Mailing Address - Phone:727-447-4255
Mailing Address - Fax:727-449-8198
Practice Address - Street 1:51 SOUTH MAIN AVENUE
Practice Address - Street 2:SUITE 315
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3934
Practice Address - Country:US
Practice Address - Phone:727-447-4255
Practice Address - Fax:727-449-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7755111N00000X
111N00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382010600Medicaid
FL382010600Medicaid