Provider Demographics
NPI:1093119968
Name:PACE, GREG (CNIM)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 COUNTRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6432
Mailing Address - Country:US
Mailing Address - Phone:405-659-9659
Mailing Address - Fax:
Practice Address - Street 1:409 E CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4224
Practice Address - Country:US
Practice Address - Phone:405-659-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic