Ennis, Gregory Mark
Ennis, Gregory Mark is an individual health care provider with primary practice located at 6401 Kimball Dr , Gig Harbor WA 98335-1228. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ennis, Gregory Mark can be contacted via phone (253) 858-9192.Contact Information
Primary practice address
6401 Kimball Dr
Gig Harbor WA 98335-1228
Phone: (253) 858-9192
Fax: (253) 985-2853
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD60105263 | Washington |
Profile Details
| NPI number | 1245220672 |
|---|---|
| LBN Legal business name | Ennis, Gregory Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 26th, 2005 |
| Last updated | Dec 3rd, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245220672 | NPPES |
| Washington | MEDICAID | 1366539421 | |
| Washington | MEDICAID | 2040574 |
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