Provider Demographics
NPI:1194104745
Name:GREGOIRE, SERGE
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5420
Mailing Address - Country:US
Mailing Address - Phone:281-616-3816
Mailing Address - Fax:
Practice Address - Street 1:117 WEST PARKWOOD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-616-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education