Provider Demographics
NPI:1891959722
Name:FREE, GREGORY PHILIP (ACA, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PHILIP
Last Name:FREE
Suffix:
Gender:M
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EL CERRITO PLAZA
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530
Mailing Address - Country:US
Mailing Address - Phone:510-526-3824
Mailing Address - Fax:510-526-3764
Practice Address - Street 1:190 EL CERRITO PLZ
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-526-3824
Practice Address - Fax:510-526-3764
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3689237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0036890Medicare PIN