Organization
GREGORY R. MACK MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY ROBERT MACK MD (OWNER)
(858) 715-9200
Entity
Organization
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
207X00000X
Orthopaedic Surgery Physician
Primary
G37547
CA
2086S0105X
Surgery of the Hand (Surgery) Physician
G37547
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G375470
—
CA
01
—
W19719
MEDICARE PTAN
CA
Enumeration date
11/01/2006
Last updated
09/22/2017
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