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NPI Code Detail

MEDICARE: DR. GREGORY JOSEPH BATHURST M.D.

MEDICARE: DR. GREGORY JOSEPH BATHURST M.D.
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
12085R0202XDiagnostic Radiology Physician539CO

General Provider Information

NPI Number : 1659347789
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY JOSEPH BATHURST M.D.
Provider Business Mailing Address
First Line : 2020 BROOK ARBOR CT
Second Line :
City : MC GREGOR
State : TX
Zip : 76657-3471
Country : US
Telephone Number : 254-845-4322
Fax Number :
Provider Business Practice Location Address
First Line : 3000 HERRING AVE
Second Line :
City : WACO
State : TX
Zip : 76708-3239
Country : US
Telephone Number : 254-202-8525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 10/17/2007

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