Provider Demographics
NPI:1720399389
Name:F KARL GREGORIUS M.D., INC.
Entity Type:Organization
Organization Name:F KARL GREGORIUS M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:GREGORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-943-0305
Mailing Address - Street 1:2209 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5503
Mailing Address - Country:US
Mailing Address - Phone:209-943-0305
Mailing Address - Fax:209-943-0402
Practice Address - Street 1:2209 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5503
Practice Address - Country:US
Practice Address - Phone:209-943-0305
Practice Address - Fax:209-943-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15246207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G152460Medicare PIN