Healthcare Provider Details

I. General information

NPI: 1225077183
Provider Name (Legal Business Name): GREGORY EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

PO BOX 660832
DALLAS TX
75266-0832
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-8200
  • Fax:
Mailing address:
  • Phone: 972-715-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DOUGLAS P WEBSTER
Title or Position: OWNER/GENERAL PARTNER
Credential: D.O.
Phone: 800-732-1066