Individual
JACK GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
590 W PUTNAM AVE, SUITE 2A, PORTERVILLE, CA 93257-3257
(559) 781-3700
(559) 781-4131
Mailing address
590 W PUTNAM AVE, SUITE 2A, PORTERVILLE, CA 93257-3257
(559) 781-3700
(559) 781-4131
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G7754
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G7754
—
CA
Enumeration date
09/26/2006
Last updated
07/08/2007
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