Healthcare Provider Details

I. General information

NPI: 1245271493
Provider Name (Legal Business Name): GARY M GREGER DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6227 FRANK AVE NW
CANTON OH
44720-8439
US

IV. Provider business mailing address

6227 FRANK AVE NW
CANTON OH
44720-8439
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-9688
  • Fax: 330-244-1966
Mailing address:
  • Phone: 330-244-9688
  • Fax: 330-244-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberOH36002696
License Number StateOH

VIII. Authorized Official

Name: MR. TIM MCGRATH
Title or Position: CREDENTIALING
Credential:
Phone: 330-479-5428