Provider Demographics
NPI:1316269095
Name:C. GREGORY JELLINEK, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:C. GREGORY JELLINEK, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:JELLINEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-587-8600
Mailing Address - Street 1:11209 BROCKWAY RD
Mailing Address - Street 2:SUIT 201
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2221
Mailing Address - Country:US
Mailing Address - Phone:530-587-8600
Mailing Address - Fax:530-587-8606
Practice Address - Street 1:11209 BROCKWAY RD
Practice Address - Street 2:SUIT 201
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-2221
Practice Address - Country:US
Practice Address - Phone:530-587-8600
Practice Address - Fax:530-587-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty