MEDICARE: DR. CLINT WALKER GREGG 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
1	207W00000X	Ophthalmology Physician	J4169	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	A005	OTHER	NM	TRIWEST
7	114027101	OTHER	TX	FIRSTCARE COMMERCIAL
8	33853	OTHER	NM	PRESBYTERIAN COMMERCIAL
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	82W450	OTHER	TX	BC/BS
11	80784Z	OTHER	TX	HMO BLUE

General Provider Information

NPI Number	:	1952392078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINT WALKER GREGG M.D.

Provider Business Mailing Address
First Line	:	925 SANTA FE DR, SUITE 105
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	855-798-2020
Fax Number	:	817-789-6290

Provider Business Practice Location Address
First Line	:	925 SANTA FE DR. SUITE 105
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086
Country	:	US
Telephone Number	:	855-798-2020
Fax Number	:	817-789-6290

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/11/2026

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