MEDICARE: JAMES GREGGO

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	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1821319013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES GREGGO

Provider Business Mailing Address
First Line	:	PO BOX 96372
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-6372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 MARGINA AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5943
Country	:	US
Telephone Number	:	520-400-7699
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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Directions to “ JAMES GREGGO ” Practice Location

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