Provider Demographics
NPI:1285849729
Name:GREGORIO, RYAN ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALBERT
Last Name:GREGORIO
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0099
Mailing Address - Country:US
Mailing Address - Phone:256-332-8969
Mailing Address - Fax:256-332-8353
Practice Address - Street 1:605 GANDY ST NE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1911
Practice Address - Country:US
Practice Address - Phone:256-332-8969
Practice Address - Fax:256-332-8353
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913923Medicaid
AL510-09585OtherAL BCBS
AL510-09585OtherAL BCBS