Provider Demographics
NPI:1770588857
Name:BLISS, GREG ALLAN (MD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:ALLAN
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 FOSTER LN
Mailing Address - Street 2:STE 101
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3239
Mailing Address - Country:US
Mailing Address - Phone:660-747-2228
Mailing Address - Fax:660-747-7677
Practice Address - Street 1:510 FOSTER LN
Practice Address - Street 2:STE 101
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3239
Practice Address - Country:US
Practice Address - Phone:660-747-2228
Practice Address - Fax:660-747-7677
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8G47207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE83344Medicare UPIN
MOY407690Medicare PIN