Healthcare Provider Details

I. General information

NPI: 1477565166
Provider Name (Legal Business Name): GREGG A GOBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 S COLORADO ST
GREENVILLE MS
38703-7211
US

IV. Provider business mailing address

PO BOX 23998
JACKSON MS
39225-3998
US

V. Phone/Fax

Practice location:
  • Phone: 662-332-8700
  • Fax:
Mailing address:
  • Phone: 662-725-2749
  • Fax: 662-725-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13979
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: