Provider Demographics
NPI:1184677452
Name:REKUC, GREGORY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:REKUC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8008
Mailing Address - Country:US
Mailing Address - Phone:919-781-9979
Mailing Address - Fax:919-781-0124
Practice Address - Street 1:3200 BLUE RIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8008
Practice Address - Country:US
Practice Address - Phone:919-781-9979
Practice Address - Fax:919-781-0124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971204Medicaid
NC209878KMedicare ID - Type Unspecified
NC8971204Medicaid