1992774111 NPI number — DEBORAH L GREGORY D.O.

Table of content: DEBORAH L GREGORY D.O. (NPI 1992774111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992774111 NPI number — DEBORAH L GREGORY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGORY
Provider First Name:
DEBORAH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992774111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 513
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENSBURG
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64093-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-429-2228
Provider Business Mailing Address Fax Number:
660-262-7418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415A BURKARTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64093-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-429-2228
Provider Business Practice Location Address Fax Number:
660-262-7418
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  118407 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 144088 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 728577 . This is a "COVENTRY HEALTHCARE OF KANSAS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26188032 . This is a "BCBS OF KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3988107 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 736648 . This is a "MISSOURI CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com