Provider Demographics
NPI:1467474999
Name:GREGERSEN, HOWARD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JOHN
Last Name:GREGERSEN
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 1:300 N SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1316
Mailing Address - Country:US
Mailing Address - Phone:805-681-5461
Mailing Address - Fax:
Practice Address - Street 1:301 N R ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5226
Practice Address - Country:US
Practice Address - Phone:805-737-6400
Practice Address - Fax:805-737-6430
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527440Medicaid
CAA52744OtherMED LICENSE
CAA52744OtherMED LICENSE