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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245220672 NPPES
Washington MEDICAID 1366539421
Washington MEDICAID 2040574

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