Healthcare Provider Details

I. General information

NPI: 1922065663
Provider Name (Legal Business Name): GREGORY D SAFFELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 5TH ST SUITE 100
RAPID CITY SD
57701-7363
US

IV. Provider business mailing address

3981 FOREST PARK CIR
RAPID CITY SD
57702-6927
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-2852
  • Fax: 605-342-3930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5035
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: