Provider Demographics
NPI:1346224201
Name:GREGG, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:GREGG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0414
Mailing Address - Country:US
Mailing Address - Phone:541-677-6111
Mailing Address - Fax:541-440-6304
Practice Address - Street 1:341 MEDICAL LOOP
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5540
Practice Address - Country:US
Practice Address - Phone:541-672-4470
Practice Address - Fax:541-672-0665
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24348207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226927Medicaid
ORR115469Medicare PIN
H80804Medicare UPIN