Provider Demographics
NPI:1356399760
Name:PAGE, GREGORY TYRONE (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:TYRONE
Last Name:PAGE
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 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1421 OAKDALE RD
Practice Address - Street 2:STANISLAUS SURGICAL HOSPITAL
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-572-2700
Practice Address - Fax:209-572-0151
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G649110Medicaid
CA00G649111Medicare ID - Type Unspecified
E77339Medicare UPIN