Provider Demographics
NPI:1407859242
Name:GREGORY, DAVID MAX (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MAX
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 1:3435 NW 56TH ST
Mailing Address - Street 2:STE 314
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4414
Mailing Address - Country:US
Mailing Address - Phone:405-946-6477
Mailing Address - Fax:405-945-4789
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:STE 314
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4414
Practice Address - Country:US
Practice Address - Phone:405-946-6477
Practice Address - Fax:405-945-4789
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8521207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE15965Medicare UPIN