Individual
DR. GREGORY MARK ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6401 KIMBALL DR, GIG HARBOR, WA 98335-1228
(253) 858-9192
(253) 985-2853
Mailing address
6401 KIMBALL DR, GIG HARBOR, WA 98335-1228
(253) 858-9192
(253) 985-2853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60105263
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366539421
—
WA
05
—
2040574
—
WA
Enumeration date
10/26/2005
Last updated
12/03/2020
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