Individual
DR. SUSAN GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1401 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2113
(817) 250-5630
Mailing address
14275 MIDWAY RD, ADDISON, TX 75001-3614
(214) 932-8255
(972) 383-2839
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
H4940
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
H4940
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184621518
NPI
—
05
—
124825401
—
TX
01
—
220018991
RR MEDICARE
TX
01
—
81P373
BCBS
TX
Enumeration date
06/30/2005
Last updated
03/09/2011
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