Provider Demographics
NPI:1386890044
Name:GREGORY K. SUELZLE, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GREGORY K. SUELZLE, M.D., A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUELZLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-0608
Mailing Address - Street 1:1330 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4928
Mailing Address - Country:US
Mailing Address - Phone:909-981-0608
Mailing Address - Fax:866-695-1267
Practice Address - Street 1:1330 SAN BERNARDINO RD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4928
Practice Address - Country:US
Practice Address - Phone:909-981-0608
Practice Address - Fax:866-695-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78385207Q00000X
CAG77184208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty