MEDICARE: ROBERT 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
1	133V00000X	Registered Dietitian	3941	OH
2	133V00000X	Registered Dietitian	393755	IL

General Provider Information

NPI Number	:	1598215303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GREGORY

Provider Business Mailing Address
First Line	:	16207 CANOVA HILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-1395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16207 CANOVA HILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-1395
Country	:	US
Telephone Number	:	513-509-3753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	10/05/2016

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Directions to “ ROBERT GREGORY ” Practice Location

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