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NPI Code Detail

MEDICARE: DR. SUSAN GREGG M.D.

MEDICARE: DR. SUSAN GREGG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0500XCytopathology PhysicianH4940TX
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianH4940TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3220018991OTHERTXRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11184621518OTHERNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
481P373OTHERTXBCBS

General Provider Information

NPI Number : 1184621518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN GREGG M.D.
Provider Business Mailing Address
First Line : 14275 MIDWAY RD
Second Line :
City : ADDISON
State : TX
Zip : 75001-3614
Country : US
Telephone Number : 214-932-8255
Fax Number : 972-383-2839
Provider Business Practice Location Address
First Line : 1401 PENNSYLVANIA AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2113
Country : US
Telephone Number : 817-250-5630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 03/09/2011

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Directions to “ DR. SUSAN GREGG M.D.” Practice Location

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