Provider Demographics
NPI:1043308844
Name:GREGORIC, IGOR DARKO (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:DARKO
Last Name:GREGORIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BATES AVE
Mailing Address - Street 2:SUITE P-514
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2607
Mailing Address - Country:US
Mailing Address - Phone:832-355-4900
Mailing Address - Fax:832-355-3770
Practice Address - Street 1:1101 BATES AVE
Practice Address - Street 2:SUITE P-514
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2607
Practice Address - Country:US
Practice Address - Phone:832-355-4900
Practice Address - Fax:832-355-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0223174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020047577OtherRAILROAD MEDICARE
TXG76810Medicare UPIN