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General NPI Number Information
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NPI Number | 1265922397
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Entity Type | Organization
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Legal Business Name | THEODORE K GREGORIUS MD INC
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 360 SAN MIGUEL DR., STE. 701
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-759-3600
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Fax | 949-759-9265
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Provider Business Mailing Address
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Address Line | 360 SAN MIGUEL DR., STE. 701
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-759-3600
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Fax | 949-759-9265
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE K GREGORIUS
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Credential | M.D.
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Telephone | 949-759-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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