Mark Conrad Gregerson, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

29943 Issued in MN

Practice address

4572 County Road 61
Moose Lake, MN 55767-9401

Phone

(218) 485-4481

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1508809930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1805 Hennepin Ave N",
            "address_purpose": "LOCATION",
            "city": "Glencoe",
            "state": "MN",
            "postal_code": "553361416",
            "country_code": "US",
            "telephone_number": "320-864-3121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREGERSON",
        "first_name": "MARK",
        "middle_name": "CONRAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "29943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "441280000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer S Gangelhoff, OTR/L
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• Nathan Wayne Gilbertson, PA-C
• Sharon Elaine Gossett, MD
• Jaclyn L Granfors
• Michael Gunnarson, DDS
• Charles Edward Habermann, DPT
• Allie Marie Hakamaki, DPT
• Keri A Halverson, CCC/SLP
• Ashley Lynae Hamblin, OD

• Orthopaedic Surgery Physician in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Orthopaedic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.