Provider Demographics
NPI:1326016023
Name:SUELZLE, GREGORY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:KENNETH
Last Name:SUELZLE
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 1:1330 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4928
Mailing Address - Country:US
Mailing Address - Phone:909-981-0608
Mailing Address - Fax:909-982-5327
Practice Address - Street 1:1330 SAN BERNARDINO RD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4928
Practice Address - Country:US
Practice Address - Phone:909-981-0608
Practice Address - Fax:909-982-5327
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77184208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G771841Medicare PIN
G23315Medicare UPIN