Provider Demographics
NPI:1346286465
Name:TOLLIVER, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100A DRAKE'S LANDING ROAD
Mailing Address - Street 2:STE 225
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-924-1214
Mailing Address - Fax:415-924-1375
Practice Address - Street 1:100A DRAKE'S LANDING ROAD
Practice Address - Street 2:STE 225
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-924-1214
Practice Address - Fax:415-924-1375
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA88295207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A882950Medicaid
CA1346286465OtherTYPE 1 NPI
H26033Medicare UPIN
CA00A882950Medicare PIN