# GREGORY R. MACK MD, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962589234
- **Authorized official:** DR. GREGORY ROBERT MACK MD (OWNER)
- **Authorized official phone:** (858) 715-9200

## Contact information

- **Practice address:** 8008 FROST ST, SUITE 403, SAN DIEGO, CA 92123-4205
- **Practice address phone:** (858) 715-9200
- **Practice address fax:** (858) 715-1230
- **Mailing address:** 8008 FROST ST, SUITE 403, SAN DIEGO, CA 92123-4205
- **Mailing address phone:** (858) 715-9200
- **Mailing address fax:** (858) 715-1230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G37547 | CA | Yes |
| 2086S0105X | Surgery of the Hand (Surgery) Physician | G37547 | CA | — |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 09/22/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G375470 | — | CA |
| 01 | — | W19719 | MEDICARE PTAN | CA |