Provider Demographics
NPI:1104924448
Name:SHOLEFF, GREGORY T (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:SHOLEFF
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 1:50 RAGSDALE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7804
Mailing Address - Country:US
Mailing Address - Phone:831-375-8824
Mailing Address - Fax:831-375-8804
Practice Address - Street 1:50 RAGSDALE DR STE 120
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7804
Practice Address - Country:US
Practice Address - Phone:831-375-8824
Practice Address - Fax:831-375-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10101207Q00000X
CAC192921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104924448Medicaid
NV1104924448OtherSMA MEDICAID
NV1104924448Medicaid
NVBF302XMedicare PIN
NVV50238OtherSMA MEDICARE PIN
NVBF302YMedicare PIN
NV1104924448Medicaid