Basic Information
Provider Information
NPI: 1972705580
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREGUREK
FirstName: STEVEN
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11025 RCA CENTER DR STE 300
Address2:  
City: PALM BEACH GARDENS
State: FL
PostalCode: 334104269
CountryCode: US
TelephoneNumber: 5613833820
FaxNumber: 8553692450
Practice Location
Address1: 7455 W WASHINGTON AVE STE 301
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 89128
CountryCode: US
TelephoneNumber: 8775625227
FaxNumber: 7029389954
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 08/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZC0006X14315NVY Allopathic & Osteopathic PhysiciansPathologyClinical Pathology

No ID Information.


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