Provider Demographics
NPI:1124074877
Name:CHANCE, GREG S (PA-C)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:S
Last Name:CHANCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3407
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:350 DEL NORTE AVENUE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-671-4182
Practice Address - Fax:530-671-4835
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16598363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC9428OtherMEDICARE RAILROAD GROUP #
CAP00243111OtherMEDICARE RAILROAD
CA0PA165982OtherINDIVIDUAL PTAN NO. CA.
ID16651210Medicare PIN
CAWPA16598AMedicare PIN
CAWPA16598DMedicare PIN
CAWPA16598GMedicare PIN
CA0PA165982OtherINDIVIDUAL PTAN NO. CA.
CACC9428OtherMEDICARE RAILROAD GROUP #
CAWPA16598BMedicare PIN
CAWPA16598HMedicare PIN
ID1665121Medicare PIN
CAAT455WMedicare PIN
CAOPA165981Medicare PIN
CAWPA16598CMedicare PIN
CAAT455VMedicare PIN
CAWPA16598FMedicare PIN
CAP00243111OtherMEDICARE RAILROAD
CAAT455ZMedicare PIN
CAWPA16598EMedicare PIN
CAWPA16598JMedicare PIN