Gregory R. Mack MD, Inc

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

G37547 Issued in CA

Legal business name

GREGORY R. MACK MD, INC

Practice address

8008 Frost St
Suite 403
San Diego, CA 92123-4205

Phone

(858) 715-9200

Fax

(858) 715-1230

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gregory Robert Mack, MD

Title

Owner

Phone

(858) 715-9200

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506038400000",
    "number": "1962589234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8008 FROST ST",
            "address_2": "SUITE 403",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234205",
            "telephone_number": "858-715-9200",
            "fax_number": "858-715-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 FROST ST",
            "address_2": "SUITE 403",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234205",
            "telephone_number": "858-715-9200",
            "fax_number": "858-715-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY R. MACK MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-09-22",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-715-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G37547",
            "primary": true
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": "CA",
            "license": "G37547",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G375470",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "W19719",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Megan Elizabeth Gregory-Mendez
• Carl Henry Gregory Jr.
• Chloe Jade Gregory

• Orthopaedic Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2017; 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.