Healthcare Provider Details

I. General information

NPI: 1477539625
Provider Name (Legal Business Name): RONALD W GREGORY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PENNA AVE
TYRONE PA
16686-1728
US

IV. Provider business mailing address

1414 9TH AVE STATION MEDICAL CENTER
ALTOONA PA
16602-2454
US

V. Phone/Fax

Practice location:
  • Phone: 814-684-2100
  • Fax: 814-684-5828
Mailing address:
  • Phone: 814-946-1655
  • Fax: 814-949-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007287E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: