Healthcare Provider Details

I. General information

NPI: 1932134368
Provider Name (Legal Business Name): TIMOTHY H GREGG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 ALEXANDRIA DR
LEXINGTON KY
40504-3229
US

IV. Provider business mailing address

2312 ALEXANDRIA DR
LEXINGTON KY
40504-3229
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-5344
  • Fax: 859-296-4101
Mailing address:
  • Phone: 859-276-5344
  • Fax: 859-296-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21507
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: