MEDICARE: DAVID MAX GREGORY 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	207RG0100X	Gastroenterology Physician	8521	OK

General Provider Information

NPI Number	:	1407859242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MAX GREGORY M.D.

Provider Business Mailing Address
First Line	:	3435 NW 56TH ST
Second Line	:	STE 314
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4414
Country	:	US
Telephone Number	:	405-946-6477
Fax Number	:	405-945-4789

Provider Business Practice Location Address
First Line	:	3435 NW 56TH ST
Second Line	:	STE 314
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4414
Country	:	US
Telephone Number	:	405-946-6477
Fax Number	:	405-945-4789

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/02/2011

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