Provider Demographics
NPI:1316034143
Name:CLIMACO, GREGORY CESAR (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CESAR
Last Name:CLIMACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1512 N GREEN MOUNT RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1953
Mailing Address - Country:US
Mailing Address - Phone:618-624-5510
Mailing Address - Fax:618-624-5529
Practice Address - Street 1:1512 N GREEN MOUNT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1953
Practice Address - Country:US
Practice Address - Phone:618-624-5510
Practice Address - Fax:618-624-5529
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036116631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine