Basic Information
Provider Information
NPI: 1730270539
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAPP
FirstName: GREGORY
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2401 DEMERS AVE
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 58201
CountryCode: US
TelephoneNumber: 7017801891
FaxNumber:  
Practice Location
Address1: 4440 S WASHINGTON ST - ALTRU PROFESSIONAL CENTER
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 58201
CountryCode: US
TelephoneNumber: 7017327000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2006
LastUpdateDate: 09/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X8661NDY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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