Provider Demographics
NPI:1023189198
Name:GREGORY, DARIN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:RAY
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 DELAFIELD STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-544-4411
Mailing Address - Fax:262-650-3856
Practice Address - Street 1:1111 DELAFIELD STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-544-4411
Practice Address - Fax:262-650-3856
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI49075-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35214100Medicaid
WI35214100Medicaid