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General NPI Number Information
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NPI Number | 1699488007
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Entity Type | Individual
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Provider Name | JOHN HOWARD GREGORY CERTIFIED ORTHOTIST
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Gender | Male
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 2020 8TH AVE STE 222
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City | WEST LINN
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State | OR
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Zip | 97068-4657
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Country | US
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Telephone | 503-344-6642
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Fax | 503-305-7045
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Provider Business Mailing Address
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Address Line | 61538 HARDIN MARTIN CT
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City | BEND
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State | OR
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Zip | 97702-3702
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Country | US
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Telephone | 503-348-7830
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Fax | 503-305-7045
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CO003723
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CO003723
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License Number State | OR
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