Provider Demographics
NPI:1831171560
Name:GRECHUS, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GRECHUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WEBER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3302
Mailing Address - Country:US
Mailing Address - Phone:573-756-9107
Mailing Address - Fax:573-756-9630
Practice Address - Street 1:1103 WEBER RD STE 203
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3302
Practice Address - Country:US
Practice Address - Phone:573-756-9107
Practice Address - Fax:573-756-9630
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5F25207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001013441Medicare ID - Type Unspecified
MO202288031Medicare ID - Type Unspecified
C51621Medicare UPIN