Basic Information
| Provider Information | |||||||||
| NPI: | 1619231594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMBARRATO | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PRUDENTIAL DR FL B11 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043886518 | ||||||||
| FaxNumber: | 9043841005 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 BILLINGSLEY RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282115020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043163070 | ||||||||
| FaxNumber: | 7043163071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 125061753 | IL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | OS14995 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2019-00971 | NC | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.