Healthcare Provider Details

I. General information

NPI: 1639516255
Provider Name (Legal Business Name): GREGORY MAXWELL GOSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MAX GOSEY M.D.

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WARNER DR
LEWISTON ID
83501-4441
US

IV. Provider business mailing address

115 E 19TH ST
ROSWELL NM
88201-5110
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-3523
  • Fax: 833-941-3874
Mailing address:
  • Phone: 575-622-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTP315
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD18516
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2024-0348
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM-17333
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA132443
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD18516
License Number StateRI
# 7
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberM-17333
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: