Provider Demographics
NPI:1336128057
Name:ISTRE, GREGORY ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROY
Last Name:ISTRE
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 795275
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-5275
Mailing Address - Country:US
Mailing Address - Phone:214-855-8510
Mailing Address - Fax:
Practice Address - Street 1:4014 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1645
Practice Address - Country:US
Practice Address - Phone:214-855-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ05362080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89311KOtherBCBS
OK100826250BMedicaid
TX136229507Medicaid
E27652Medicare UPIN