Provider Demographics
NPI:1194799650
Name:DOUGLAS, GREGORY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWARD
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9281 OFFICE PARK CIR
Mailing Address - Street 2:120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8068
Mailing Address - Country:US
Mailing Address - Phone:916-896-1650
Mailing Address - Fax:916-896-1959
Practice Address - Street 1:9281 OFFICE PARK CIR
Practice Address - Street 2:120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8068
Practice Address - Country:US
Practice Address - Phone:916-896-1650
Practice Address - Fax:916-896-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC39164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C391640Medicaid
CA00C391641Medicaid
CA00C391641Medicaid
00C391340Medicare PIN