Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD2021-0736 | NM |
N | 208200000X | Surgeon | 65599 | MN |
N | 208600000X | Surgeon | 65599 | MN |
NPI | 1699118174 |
---|---|
Provider Name | Gregory Larrieux |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 20/07/2021 |