MEDICARE: DR. JONATHAN M GREGORY M.D., FACC

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
1	207RC0000X	Cardiovascular Disease Physician	21611	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417940792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN M GREGORY M.D., FACC

Provider Business Mailing Address
First Line	:	1414 GLEASONS LANDING DR
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3814
Country	:	US
Telephone Number	:	843-838-4208
Fax Number	:	843-838-3779

Provider Business Practice Location Address
First Line	:	1414 GLEASONS LANDING DR
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-3814
Country	:	US
Telephone Number	:	843-838-4208
Fax Number	:	843-838-3779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/10/2009

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