Provider Demographics
NPI:1588074959
Name:GRETHER, DUSTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:GRETHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CAMINO RAMON FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1354
Mailing Address - Country:US
Mailing Address - Phone:925-244-7460
Mailing Address - Fax:
Practice Address - Street 1:2300 CAMINO RAMON FL 3
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1354
Practice Address - Country:US
Practice Address - Phone:925-244-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5505213ES0103X
CAEL6780213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery