Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | IL | |
Y | 213ER0200X | Radiology | IL |
NPI | 1659355139 |
---|---|
Provider Name | Dr. Douglas M. Gregerson |
First Address | Geneva, IL 60134 |
Second Address | Geneva, IL 60134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |