Healthcare Provider Details

I. General information

NPI: 1346224201
Provider Name (Legal Business Name): PATRICK J GREGG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 MEDICAL LOOP SUITE 120
ROSEBURG OR
97471-5540
US

IV. Provider business mailing address

PO BOX 1700
ROSEBURG OR
97470-0414
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-4470
  • Fax: 541-672-0665
Mailing address:
  • Phone: 541-677-6111
  • Fax: 541-440-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD24348
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: