Basic Information
| Provider Information | |||||||||
| NPI: | 1023098324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEBB | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107637363 | ||||||||
| FaxNumber: | 9102518296 | ||||||||
| Practice Location | |||||||||
| Address1: | 1414 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107637363 | ||||||||
| FaxNumber: | 9102518296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9700857 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8910838 | 05 | NC | MEDICAID |