MEDICARE: DR. GARY A GREGO 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
1	207Q00000X	Family Medicine Physician	35060999G	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000024657	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1396726303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY A GREGO M.D.

Provider Business Mailing Address
First Line	:	1400 E 2ND ST
Second Line	:
City	:	DEFIANCE
State	:	OH
Zip	:	43512-2440
Country	:	US
Telephone Number	:	419-784-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 NORTH STREET
Second Line	:
City	:	NAPOLEON
State	:	OH
Zip	:	43545
Country	:	US
Telephone Number	:	419-599-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/03/2010

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