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General NPI Number Information
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NPI Number | 1619020484
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Entity Type | Organization
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Legal Business Name | GREGORY J WITHERS MD INC A MEDICAL CORP
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 301 W HUNTINGTON DR SUITE 407
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City | ARCADIA
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State | CA
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Zip | 91007-3462
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Country | US
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Telephone | 626-821-3440
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Fax | 626-821-0709
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Provider Business Mailing Address
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Address Line | 301 W HUNTINGTON DR SUITE 407
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City | ARCADIA
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State | CA
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Zip | 91007-3462
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Country | US
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Telephone | 626-821-3440
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Fax | 626-821-0709
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY J. WITHERS
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Credential | M.D.
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Telephone | 626-821-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | G27800
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License Number State | CA
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