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General NPI Number Information
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NPI Number | 1598952905
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Entity Type | Individual
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Provider Name | KELLY RAY GREGG M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 09/29/2007
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Provider Practice Location Address
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Address Line | 13779 EASTONVILLE RD
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City | ELBERT
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State | CO
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Zip | 80106-8962
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Country | US
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Telephone | 719-321-3719
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Fax |
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Provider Business Mailing Address
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Address Line | 13779 EASTONVILLE RD
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City | ELBERT
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State | CO
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Zip | 80106-8962
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Country | US
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Telephone | 719-321-3719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 27394
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License Number State | CO
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