Provider Demographics
NPI:1326060815
Name:GREGORY, LINDA DIANE (DO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MAIN ST STE 5200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7365
Mailing Address - Country:US
Mailing Address - Phone:214-712-2000
Mailing Address - Fax:214-712-2444
Practice Address - Street 1:1717 MAIN ST STE 5200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7365
Practice Address - Country:US
Practice Address - Phone:214-712-2000
Practice Address - Fax:214-712-2444
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4440207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00853230OtherRRMCARE
TX213191409Medicaid
TX213191409Medicaid
TXTXB104781Medicare PIN