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General NPI Number Information
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NPI Number | 1679762702
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Entity Type | Organization
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Legal Business Name | GREGGORY R. DEVORE M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 50 ALESSANDRO PL STE 330
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City | PASADENA
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State | CA
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Zip | 91105-3187
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Country | US
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Telephone | 626-583-8911
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Fax | 626-583-8894
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Provider Business Mailing Address
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Address Line | 50 ALESSANDRO PL STE 330
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City | PASADENA
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State | CA
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Zip | 91105-3187
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Country | US
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Telephone | 626-583-8911
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Fax | 626-583-8894
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGGORY RUSSELL DEVORE
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Credential | M.D.
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Telephone | 626-583-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G44446
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License Number State | CA
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