MEDICARE: GREGG L. SMALL 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	207VG0400X	Gynecology Physician	G5621	TX

General Provider Information

NPI Number	:	1356384358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGG L. SMALL M.D.

Provider Business Mailing Address
First Line	:	9301 N CENTRAL EXPY
Second Line	:	SUITE 590
City	:	DALLAS
State	:	TX
Zip	:	75231-0806
Country	:	US
Telephone Number	:	214-265-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	9301 N CENTRAL EXPY
Second Line	:	SUITE 590
City	:	DALLAS
State	:	TX
Zip	:	75231-0806
Country	:	US
Telephone Number	:	214-265-6001
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/13/2008

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