Provider Demographics
NPI:1285039651
Name:MICHAS, GREGORY TAYLOR (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:TAYLOR
Last Name:MICHAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1601 CUMMINS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6411
Mailing Address - Country:US
Mailing Address - Phone:510-900-3125
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK RD STE 270
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2078
Practice Address - Country:US
Practice Address - Phone:925-944-9711
Practice Address - Fax:925-944-9709
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLU035332084P0800X
CA20A155862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry