Provider Demographics
NPI:1295817112
Name:SICARD, GREGORIO A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:A
Last Name:SICARD
Suffix:JR
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 1:500 N COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1299
Mailing Address - Country:US
Mailing Address - Phone:503-397-0471
Mailing Address - Fax:
Practice Address - Street 1:500 N COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1299
Practice Address - Country:US
Practice Address - Phone:503-397-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine