Healthcare Provider Details

I. General information

NPI: 1487624391
Provider Name (Legal Business Name): GREGORY B HEMSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 HARLOW RD STE 5
SPRINGFIELD OR
97477-1339
US

IV. Provider business mailing address

498 HARLOW RD STE 5
SPRINGFIELD OR
97477-1339
US

V. Phone/Fax

Practice location:
  • Phone: 541-681-8446
  • Fax:
Mailing address:
  • Phone: 541-681-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18410
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD18410
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: