Provider Demographics
NPI:1023006418
Name:GARNER, GREGG (DO)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:GARNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 TORRANCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3746
Mailing Address - Country:US
Mailing Address - Phone:858-499-4421
Mailing Address - Fax:858-636-2001
Practice Address - Street 1:1684 TORRANCE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3746
Practice Address - Country:US
Practice Address - Phone:858-499-4421
Practice Address - Fax:858-636-2001
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6253207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
20A6253Medicare ID - Type Unspecified