Provider Demographics
NPI:1003842907
Name:LESSLY, GREGG A (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:LESSLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:906 WEST MCDERMOTT DRIVE
Mailing Address - Street 2:#116-371
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:469-541-1600
Mailing Address - Fax:469-541-1612
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-541-1600
Practice Address - Fax:469-541-1612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8412207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE093OtherBCBS
TX8P0970OtherBLUE SHIELD
TXP00719299OtherRAILROAD
TX169347501Medicaid
TX169347503Medicaid
TX169347502Medicaid
TX8L2631Medicare PIN
TX169347503Medicaid
TX8K9920Medicare PIN
TX8C7194Medicare PIN