MEDICARE: DONALD J. GREGGAIN, M.D. PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0203406	OTHER	WA	DL&I GROUP NUMBER
2	000010017948	OTHER	ID	REGENCE GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8J935	OTHER	ID	BX/GROUP NUMBER

General Provider Information

NPI Number	:	1194786103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD J. GREGGAIN, M.D. PS

Provider Business Mailing Address
First Line	:	1271 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2846
Country	:	US
Telephone Number	:	509-751-1500
Fax Number	:	509-751-1504

Provider Business Practice Location Address
First Line	:	1271 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2846
Country	:	US
Telephone Number	:	509-751-1500
Fax Number	:	509-751-1504

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DEBBIE J. ALLBEE
Credential	:
Telephone Number	:	509-751-1500

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/05/2007

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