Individual
GEORGE GREGORY SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ONE HOAG DR, ECU DEPT, NEWPORT BEACH, CA 92663-4162
(949) 764-5689
(405) 751-3183
Mailing address
PO BOX 720300, OKLAHOMA CITY, OK 73172-0300
(800) 749-4560
(405) 751-3181
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C32629
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C326290
BLUE SHIELD
CA
05
—
00C326290
—
CA
05
—
00C326290670
—
CA
01
—
P00242844
RR MEDICARE
CA
Enumeration date
04/11/2006
Last updated
09/20/2012
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