Individual
GREGORY S DEFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5625 CENEX DR, INVER GROVE HEIGHTS, MN 55077-1724
(651) 552-2600
(651) 552-2614
Mailing address
8170 33RD AVE S, MS21110Q, BLOOMINGTON, MN 55425-4516
(651) 552-2600
(651) 552-2614
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38410
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067718300
—
MN
Enumeration date
04/12/2006
Last updated
07/21/2022
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