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General NPI Number Information
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NPI Number | 1255762506
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Entity Type | Organization
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Legal Business Name | GARY GREGERSON, M.D., P.A.
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 1611 12TH AVE RD SUITE A
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City | NAMPA
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State | ID
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Zip | 83686-7715
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Country | US
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Telephone | 208-468-9400
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Fax | 208-468-9447
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Provider Business Mailing Address
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Address Line | 1611 12TH AVE RD SUITE A
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City | NAMPA
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State | ID
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Zip | 83686-7715
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Country | US
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Telephone | 208-468-9400
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Fax | 208-468-9447
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY NED GREGERSON
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Credential |
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Telephone | 208-468-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M-6312
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License Number State | ID
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