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General NPI Number Information
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NPI Number | 1780783183
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Entity Type | Individual
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Provider Name | GREGORY G ENNIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 4100 COVERT AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-5559
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Country | US
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Telephone | 812-476-9983
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Fax | 812-476-3809
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax | 812-473-5822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 01051903A
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License Number State | IN
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