Individual
DR. GREGG ROBERT MAKOVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
717 S AVERILL AVE, SAN PEDRO, CA 90732-3813
(310) 548-6298
Mailing address
717 S AVERILL AVE, SAN PEDRO, CA 90732-3813
(310) 548-6298
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2521
CA
213EP1101X
Primary Podiatric Medicine Podiatrist
E2521
CA
213ES0131X
Foot Surgery Podiatrist
E2521
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E25210
—
CA
Enumeration date
11/10/2006
Last updated
03/27/2012
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