Provider Demographics
NPI:1508844648
Name:KLIS, GREGORY R (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:R
Last Name:KLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8823
Mailing Address - Country:US
Mailing Address - Phone:661-663-4800
Mailing Address - Fax:661-663-4871
Practice Address - Street 1:100 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8823
Practice Address - Country:US
Practice Address - Phone:661-663-4800
Practice Address - Fax:661-663-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ72627ZMedicare ID - Type Unspecified
G43566Medicare UPIN