Individual
FREDERICK KARL GREGORIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2209 N CALIFORNIA ST, STOCKTON, CA 95204-5503
(209) 943-0305
(209) 943-0210
Mailing address
2209 N CALIFORNIA ST, STOCKTON, CA 95204-5503
(209) 943-0305
(209) 943-0210
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G15246
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94-2650763
TAX ID
CA
Enumeration date
07/18/2006
Last updated
06/18/2010
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