Basic Information
| Provider Information | |||||||||
| NPI: | 1295938553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TITUS | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10835 N 25TH AVE | ||||||||
| Address2: | STE 240 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850293458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
| FaxNumber: | 6022462566 | ||||||||
| Practice Location | |||||||||
| Address1: | 7026 OLD KATY RD STE 276 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133580562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 76661 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.