Healthcare Provider Details

I. General information

NPI: 1609803006
Provider Name (Legal Business Name): GREGORY LEE EADS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MEDICAL PLAZA DR SUITE 200
THE WOODLANDS TX
77380-3242
US

IV. Provider business mailing address

1120 MEDICAL PLAZA DR SUITE 200
THE WOODLANDS TX
77380-3242
US

V. Phone/Fax

Practice location:
  • Phone: 832-813-0979
  • Fax: 832-813-0984
Mailing address:
  • Phone: 832-813-0979
  • Fax: 832-813-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101049545
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM4048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: