Provider Demographics
NPI:1255337622
Name:BISSONETTE, FREY, GREENBERG, GREER, MALKUS, SPRINGER
Entity type:Organization
Organization Name:BISSONETTE, FREY, GREENBERG, GREER, MALKUS, SPRINGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:CASS
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-464-1608
Mailing Address - Street 1:6280 JACKSON DR
Mailing Address - Street 2:STE 8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3436
Mailing Address - Country:US
Mailing Address - Phone:619-464-1608
Mailing Address - Fax:619-641-8738
Practice Address - Street 1:6280 JACKSON DR
Practice Address - Street 2:STE 8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3436
Practice Address - Country:US
Practice Address - Phone:619-464-1608
Practice Address - Fax:619-641-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty