Provider Demographics
NPI:1861785651
Name:URICK, GREG
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:URICK
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:SR 108 BLDG 3005
Mailing Address - Street 2:DEWERT BRANCH MEDICAL CLINIC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:93517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SR 108 BLDG 3005
Practice Address - Street 2:DEWERT BRANCH MEDICAL CLINIC
Practice Address - City:BRIDGEPORT
Practice Address - State:CA
Practice Address - Zip Code:93517
Practice Address - Country:US
Practice Address - Phone:760-932-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman