Healthcare Provider Details

I. General information

NPI: 1427166453
Provider Name (Legal Business Name): PAUL R GREGORY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE SUITE 212
CARMICHAEL CA
95608-6333
US

IV. Provider business mailing address

6620 COYLE AVE SUITE 212
CARMICHAEL CA
95608-6333
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-9455
  • Fax: 916-536-9424
Mailing address:
  • Phone: 916-536-9455
  • Fax: 916-536-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberG85411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: