Individual
JOHN GREGORY MODRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
K6159
TX
2086S0129X
Vascular Surgery Physician
E-7074
AR
2086S0129X
Vascular Surgery Physician
Primary
K6159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106174903
—
TX
01
—
8D1525
MEDICARE
TX
Enumeration date
10/25/2006
Last updated
10/19/2015
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