Basic Information
| Provider Information | |||||||||
| NPI: | 1851561377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGORY | ||||||||
| FirstName: | HUGH | ||||||||
| MiddleName: | ELLIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1060 HOWARD ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157480136 | ||||||||
| FaxNumber: | 4158634867 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 HOWARD ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157480136 | ||||||||
| FaxNumber: | 4158634867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.