Provider Demographics
NPI:1396830626
Name:GREGORY, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GREGORY
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 1:2525 E CAMELBACK RD
Mailing Address - Street 2:1100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4219
Mailing Address - Country:US
Mailing Address - Phone:602-778-3600
Mailing Address - Fax:
Practice Address - Street 1:2525 E CAMELBACK RD
Practice Address - Street 2:1100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4219
Practice Address - Country:US
Practice Address - Phone:602-778-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty