Provider Demographics
NPI:1538117197
Name:DOPULOS, GREGORY GAMLIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GAMLIEL
Last Name:DOPULOS
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 1:11701 EAGLE ROCK NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-4121
Mailing Address - Country:US
Mailing Address - Phone:505-822-8192
Mailing Address - Fax:
Practice Address - Street 1:11701 EAGLE ROCK NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-4121
Practice Address - Country:US
Practice Address - Phone:505-822-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-41207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME4192Medicaid
NME66066Medicare UPIN
NM344528304Medicare ID - Type Unspecified