Healthcare Provider Details

I. General information

NPI: 1689680043
Provider Name (Legal Business Name): JULIA GREGORY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

IV. Provider business mailing address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-0125
  • Fax: 479-750-0323
Mailing address:
  • Phone: 479-750-0125
  • Fax: 479-750-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE4920
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: