Individual
MARK CONRAD GREGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
(218) 485-4481
Mailing address
4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
(218) 485-4481
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
29943
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441280000
—
MN
Enumeration date
06/14/2006
Last updated
11/01/2019
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