Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | A52095 | CA |
N | 207SG0201X | Clinical Genetics (M.D.) | MD-12592 | HI |
NPI | 1508961897 |
---|---|
Provider Name | Dr. Gregory Mark Enns |
First Address | Palo Alto, CA 94305-5208 |
Second Address | Palo Alto, CA 94305-5208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52095 | MEDICAL LICENSE (01) | CA |
BE3995048 | DEA LICENSE (01) | CA |
G71777 | (02) | CA |
MD-12592 | MEDICAL LICENSE (01) | HI |