1346809522 NPI number — DR. GREGORY JOHN CALVIN SUE DO

Table of content: DR. GREGORY JOHN CALVIN SUE DO (NPI 1346809522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346809522 NPI number — DR. GREGORY JOHN CALVIN SUE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUE
Provider First Name:
GREGORY
Provider Middle Name:
JOHN CALVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346809522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1363 ABERDEEN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SANDS MISSILE RANGE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-674-3500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1363 ABERDEEN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SANDS MISSILE RANGE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-674-3505
Provider Business Practice Location Address Fax Number:
915-742-7459
Provider Enumeration Date:
06/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: DR.0065014 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com