Provider Demographics
NPI:1518059229
Name:JOSSART, GREGG (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:JOSSART
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-600-0440
Mailing Address - Fax:415-369-1368
Practice Address - Street 1:1100 VAN NESS AVE FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6920
Practice Address - Country:US
Practice Address - Phone:415-600-0440
Practice Address - Fax:415-369-1368
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA630939208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75072OtherSTATE MEDICAL LICENSE
CARHC00148391OtherFLOUROSCOPY CERTIFCATION