MEDICARE: DR. GREGORY DANIEL SPIN D.O.

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	207RN0300X	Nephrology Physician	20A7602	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A7602	OTHER	CA	OSTEOPATH MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114977386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY DANIEL SPIN D.O.

Provider Business Mailing Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1205
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-789-1505
Fax Number	:	916-789-1513

Provider Business Practice Location Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1205
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-789-1505
Fax Number	:	916-789-1513

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/15/2014

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