Provider Demographics
NPI:1245278506
Name:GREKIN, ROY C (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:C
Last Name:GREKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:2320 BATH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4339
Practice Address - Country:US
Practice Address - Phone:805-569-1164
Practice Address - Fax:805-569-1094
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G510120Medicaid
CACQ929VOtherMEDICARE PTAN
CAG510120Medicaid
CA00G510120Medicaid
CACQ929VOtherMEDICARE PTAN