MEDICARE: KASEY DIANE GREGORY MD

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	MD176129	OR

General Provider Information

NPI Number	:	1912240854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY DIANE GREGORY MD

Provider Business Mailing Address
First Line	:	2865 DAGGETT AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 ALMOND ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1116
Country	:	US
Telephone Number	:	541-274-8690
Fax Number	:

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	10/20/2016

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