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NPI Code Detail

MEDICARE: DR. DONALD J GREGGAIN M.D.

MEDICARE: DR. DONALD J GREGGAIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician32331WA
2207Q00000XFamily Medicine PhysicianM-6680ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080075556OTHERRAILROAD MEDICARE PROV#
41139282OTHERIDIDAHO MEDICARE PROV #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010001249OTHERIDREGENCE BLUE SHIELD PROV
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5193254001OTHEROWCP PROV #
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
771993 8J935OTHERIDBLUE CROSS IDAHO PROV#
8104012OTHERWADL&I PROV NUMBER
9MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154328052
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD J GREGGAIN M.D.
Provider Business Mailing Address
First Line : 415 6TH STREET
Second Line : ATTN: PHYSICIAN SERVICES
City : LEWISTON
State : ID
Zip : 83501-2434
Country : US
Telephone Number : 208-750-7462
Fax Number : 208-750-7467
Provider Business Practice Location Address
First Line : 415 6TH ST STE 3C
Second Line :
City : LEWISTON
State : ID
Zip : 83501-2431
Country : US
Telephone Number : 208-750-3840
Fax Number : 208-750-3839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 12/26/2024

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