Basic Information
Provider Information
NPI: 1023064342
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASLANIAN
FirstName: GREGORY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5700 LAKE WORTH RD
Address2: #204
City: LAKE WORTH
State: FL
PostalCode: 33463
CountryCode: US
TelephoneNumber: 5619687968
FaxNumber: 5619644603
Practice Location
Address1: 10075 S JOG RD
Address2: STE 300
City: BOYNTON BEACH
State: FL
PostalCode: 334373535
CountryCode: US
TelephoneNumber: 5617379227
FaxNumber: 5617378581
Other Information
ProviderEnumerationDate: 05/26/2006
LastUpdateDate: 04/20/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME39528FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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