Provider Demographics
NPI:1821074709
Name:RISS, GRETCHEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:B
Last Name:RISS
Suffix:
Gender:F
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:USS PELELIU
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96624-1620
Mailing Address - Country:US
Mailing Address - Phone:619-556-5351
Mailing Address - Fax:
Practice Address - Street 1:USS PELELIU
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96624-1620
Practice Address - Country:US
Practice Address - Phone:619-556-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine