Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A84930 | CA |
NPI | 1013950450 |
---|---|
Provider Name | Theodore K. Gregorius |
First Address | Newport Beach, CA 92660-5927 |
Second Address | Newport Beach, CA 92660-5927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 03/02/2022 |