Provider Demographics
NPI:1144377433
Name:FALK, GREGORY ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:FALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417-0888
Mailing Address - Country:US
Mailing Address - Phone:541-839-4211
Mailing Address - Fax:541-839-4983
Practice Address - Street 1:115 SW PINE
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-0198
Practice Address - Country:US
Practice Address - Phone:541-839-4211
Practice Address - Fax:541-839-4858
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR284208Medicaid
ORC90866Medicare UPIN
OR284208Medicaid