Provider Demographics
NPI:1750377941
Name:GENOVA, GREGORY P (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:GENOVA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3617
Mailing Address - Country:US
Mailing Address - Phone:636-695-2520
Mailing Address - Fax:636-695-2526
Practice Address - Street 1:5551 WINGHAVEN BLVD STE 250
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3630
Practice Address - Country:US
Practice Address - Phone:636-685-7724
Practice Address - Fax:314-590-5914
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-08-25
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Provider Licenses
StateLicense IDTaxonomies
MOMDR3C40207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110229354OtherRR MEDICARE
MOP00254751OtherRR MEDICARE
MOP00254751OtherRR MEDICARE
MO000006617Medicare ID - Type Unspecified
MOA10080Medicare UPIN