Organization
DOWNEY DERMATOLOGIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE PATRICK GREESON M.D. (PRESIDENT)
(562) 869-2478
Entity
Organization
Contact information
Practice address
11480 BROOKSHIRE AVE STE 109, DOWNEY, CA 90241-5022
(562) 869-2478
(562) 861-1229
Mailing address
11480 BROOKSHIRE AVE STE 109, DOWNEY, CA 90241-5022
(562) 869-2478
(562) 861-1229
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070008435
RAILROAD MEDICARE
CA
01
—
070008463
RAILROAD MEDICARE
CA
01
—
DD1100
RAILROAD MEDICARE
CA
05
—
GR0085810
—
CA
01
—
ZZZ98655Z
BLUE SHIELD
CA
Enumeration date
10/24/2006
Last updated
10/27/2010
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