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General NPI Number Information
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NPI Number | 1720399389
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Entity Type | Organization
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Legal Business Name | F KARL GREGORIUS M.D., INC.
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 2209 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-5503
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Country | US
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Telephone | 209-943-0305
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Fax | 209-943-0402
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Provider Business Mailing Address
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Address Line | 2209 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-5503
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Country | US
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Telephone | 209-943-0305
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Fax | 209-943-0402
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. FREDERICK KARL GREGORIUS
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Credential | M.D.
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Telephone | 209-943-0305
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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 | G15246
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License Number State | CA
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