Provider Demographics
NPI:1003953662
Name:HOUSTON, GREGORY HOWARD (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:HOWARD
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 510
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3509
Mailing Address - Country:US
Mailing Address - Phone:205-971-1750
Mailing Address - Fax:205-971-1751
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 510
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3509
Practice Address - Country:US
Practice Address - Phone:205-971-1750
Practice Address - Fax:205-971-1751
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA184363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S30510Medicare UPIN
000029016Medicare ID - Type Unspecified