Provider Demographics
NPI:1366478737
Name:TEMPEST, GREGORY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RICHARD
Last Name:TEMPEST
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 1:2121 LOHMANS CROSSING RD # 504-177
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5217
Mailing Address - Country:US
Mailing Address - Phone:512-462-6634
Mailing Address - Fax:512-462-6795
Practice Address - Street 1:1106 W DITTMAR RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6328
Practice Address - Country:US
Practice Address - Phone:512-462-6634
Practice Address - Fax:512-462-6795
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0941207R00000X, 2084N0400X
TXM04912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206418001Medicaid
TX192637002Medicaid
TX206418001Medicaid
TX0A5033Medicare PIN