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NPI Code Detail

MEDICARE: AVIS B GREGORY

MEDICARE: AVIS B GREGORY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1407588106
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVIS B GREGORY
Provider Business Mailing Address
First Line : 4240 N EUCLID AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63115-2165
Country : US
Telephone Number : 314-378-6712
Fax Number :
Provider Business Practice Location Address
First Line : 1716 CORPORATE XING
Second Line :
City : O FALLON
State : IL
Zip : 62269-3734
Country : US
Telephone Number : 302-334-8216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2022
Last Update Date : 06/30/2022

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Directions to “ AVIS B GREGORY ” Practice Location

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