Provider Demographics
NPI:1669475430
Name:SPOWART, GREGORY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:SPOWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:FL 2
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:650-934-3546
Mailing Address - Fax:650-691-6193
Practice Address - Street 1:23845 HOLMAN HWY
Practice Address - Street 2:STE 220
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5900
Practice Address - Country:US
Practice Address - Phone:831-644-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49645208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G496450Medicaid
CA00G496450Medicare ID - Type Unspecified
CA00G496450Medicaid