Provider Demographics
NPI:1295937555
Name:PRIMUS, GREGORY LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAMAR
Last Name:PRIMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7543 183RD ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6208
Mailing Address - Country:US
Mailing Address - Phone:708-263-2000
Mailing Address - Fax:708-263-2023
Practice Address - Street 1:7543 183RD ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6208
Practice Address - Country:US
Practice Address - Phone:708-263-2000
Practice Address - Fax:708-263-2023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036 118611207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine