MEDICARE: DR. JAMES RICHARD GREGORY MD

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	27041	OK

General Provider Information

NPI Number	:	1912132390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RICHARD GREGORY MD

Provider Business Mailing Address
First Line	:	940 NE 13TH ST
Second Line	:	MRI 2000/ SUITE 2009
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-6458
Fax Number	:	140-571-1502

Provider Business Practice Location Address
First Line	:	1200 CHILDRENS AVE
Second Line	:	SUITE 3A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4637
Country	:	US
Telephone Number	:	405-271-2669
Fax Number	:	405-271-5320

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	08/06/2015

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