# JOHN GREGORY MODRALL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1457435398
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | K6159 | TX | — |
| 2086S0129X | Vascular Surgery Physician | E-7074 | AR | — |
| 2086S0129X | Vascular Surgery Physician | K6159 | TX | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 10/19/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 106174903 | — | TX |
| 01 | — | 8D1525 | MEDICARE | TX |