Healthcare Provider Details

I. General information

NPI: 1871581512
Provider Name (Legal Business Name): JAY LANCE GREGSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 N HIGHWAY 81
DUNCAN OK
73533-1449
US

IV. Provider business mailing address

2004 N HIGHWAY 81
DUNCAN OK
73533-1449
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-1911
  • Fax: 580-252-1020
Mailing address:
  • Phone: 580-252-1911
  • Fax: 580-252-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20226
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20226
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: