Provider Demographics
NPI:1346577343
Name:JAY GREGORY, M.D., INC. P.C.
Entity Type:Organization
Organization Name:JAY GREGORY, M.D., INC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-687-5304
Mailing Address - Street 1:333 S 38TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4937
Mailing Address - Country:US
Mailing Address - Phone:918-687-5304
Mailing Address - Fax:918-687-0178
Practice Address - Street 1:333 S 38TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4937
Practice Address - Country:US
Practice Address - Phone:918-687-5304
Practice Address - Fax:918-687-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100105610AMedicaid
OK443481212001OtherBLUE CROSS BLUE SHIELD
OK443481212001OtherBLUE CROSS BLUE SHIELD