Provider Demographics
NPI:1366659476
Name:ADAMS, GREGORY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 HERITAGE WAY
Mailing Address - Street 2:2300
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-752-8456
Mailing Address - Fax:406-755-1088
Practice Address - Street 1:350 HERITAGE WAY
Practice Address - Street 2:2300
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3158
Practice Address - Country:US
Practice Address - Phone:406-752-8456
Practice Address - Fax:406-755-1088
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORLL15957208800000X
MT19082208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1891886867OtherMEDICARE GROUP NPI