MEDICARE: THEODORE K. GREGORIUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	A84930	CA

General Provider Information

NPI Number	:	1013950450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE K. GREGORIUS M.D.

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR STE 701
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5927
Country	:	US
Telephone Number	:	949-759-3600
Fax Number	:	909-881-7593

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 701
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5927
Country	:	US
Telephone Number	:	949-759-3600
Fax Number	:	949-759-5017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/03/2022

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