Healthcare Provider Details

I. General information

NPI: 1013379809
Provider Name (Legal Business Name): COREY GREGG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

11880 N AVIARY DR
HOLLYWOOD FL
33026-3636
US

V. Phone/Fax

Practice location:
  • Phone: 954-551-1683
  • Fax:
Mailing address:
  • Phone: 954-551-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322270
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number322270
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: