Healthcare Provider Details

I. General information

NPI: 1598340044
Provider Name (Legal Business Name): GREGORY ROBERT BILLINGS MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W RIO SALADO PKWY STE 107
TEMPE AZ
85281-2892
US

IV. Provider business mailing address

4725 E ARGENTITE ST
SAN TAN VALLEY AZ
85143-5128
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-0071
  • Fax:
Mailing address:
  • Phone: 480-686-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number8367
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8367
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: