Individual
DR. GREGOR G CLEVELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1303 AZALEA CT, SUITE C, MYRTLE BEACH, SC 29577-5765
(843) 692-0570
(843) 497-9566
Mailing address
1303 AZALEA CT, STE C, MYRTLE BEACH, SC 29577-5765
(843) 692-0570
(843) 497-9566
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
15902
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05905
BCBS OF NC
NC
01
—
154758900
FEDERAL BLACK LUNG
SC
05
—
159027
—
SC
01
—
300049800
RAILROAD MEDICARE
SC
01
—
570525838
STANDARD TAX ID
SC
01
—
60773
MEDCOST
SC
01
—
890603R
MEDICAID OF NC
NC
Enumeration date
09/29/2005
Last updated
09/13/2016
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