Healthcare Provider Details

I. General information

NPI: 1154328052
Provider Name (Legal Business Name): DONALD J GREGGAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST STE 3C
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

415 6TH STREET ATTN: PHYSICIAN SERVICES
LEWISTON ID
83501-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-750-3840
  • Fax: 208-750-3839
Mailing address:
  • Phone: 208-750-7462
  • Fax: 208-750-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32331
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-6680
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: