Provider Demographics
NPI:1154328052
Name:GREGGAIN, DONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:GREGGAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:222 SOUTHWAY AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2703
Mailing Address - Country:US
Mailing Address - Phone:208-750-3840
Mailing Address - Fax:208-750-3839
Practice Address - Street 1:222 SOUTHWAY AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-750-3840
Practice Address - Fax:208-750-3839
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA32331207Q00000X
IDM-6680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA104012OtherDL&I PROV NUMBER
ID71993 8J935OtherBLUE CROSS IDAHO PROV#
ID000010001249OtherREGENCE BLUE SHIELD PROV
ID003310000Medicaid
193254001OtherOWCP PROV #
WA1095264OtherWASH MEDICAID PROV #
ID1139282OtherIDAHO MEDICARE PROV #
080075556OtherRAILROAD MEDICARE PROV#
WA1095264OtherWASH MEDICAID PROV #
ID1139282OtherIDAHO MEDICARE PROV #