Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | L0223 | TX |
NPI | 1043308844 |
---|---|
Provider Name | Dr. Igor Darko Gregoric |
First Address | Houston, TX 77030-2607 |
Second Address | Houston, TX 77030-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020047577 | RAILROAD MEDICARE (01) | TX |
G76810 | (02) | TX |