Healthcare Provider Details

I. General information

NPI: 1639304462
Provider Name (Legal Business Name): RICHARD D GREGORY MD INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 E ALLUVIAL AVE 101
FRESNO CA
93720-2686
US

IV. Provider business mailing address

PO BOX 3342
PINEDALE CA
93650-3342
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-6226
  • Fax: 559-440-9005
Mailing address:
  • Phone: 559-436-0871
  • Fax: 559-436-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG75677
License Number StateCA

VIII. Authorized Official

Name: RICHARD D GREGORY
Title or Position: PRESIDENT
Credential: MD
Phone: 559-431-6226