Provider Demographics
NPI:1104891290
Name:MIDDLETON, GREGORY DAVID (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVID
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 CAMPUS POINT DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1300
Mailing Address - Country:US
Mailing Address - Phone:858-657-8200
Mailing Address - Fax:858-657-8235
Practice Address - Street 1:9350 CAMPUS POINT DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-8200
Practice Address - Fax:858-657-8235
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9639207RR0500X
CAC54037207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018674Medicaid
F83986Medicare UPIN
NV2018674Medicaid