Individual
DR. GREGORY R MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8008 FROST ST, SUITE 403, SAN DIEGO, CA 92123-4205
(858) 715-9200
(858) 715-1230
Mailing address
8008 FROST ST, SUITE 403, SAN DIEGO, CA 92123-4205
(858) 715-9200
(858) 715-1230
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
G37547
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G375470
—
CA
01
—
W19719
MEDICARE PTAN
—
Enumeration date
09/25/2006
Last updated
08/06/2013
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