Provider Demographics
NPI:1417995200
Name:GREGORY-LAINE, GALE (DO)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:
Last Name:GREGORY-LAINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3321
Mailing Address - Country:US
Mailing Address - Phone:830-249-9995
Mailing Address - Fax:830-249-9868
Practice Address - Street 1:1421 S MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3321
Practice Address - Country:US
Practice Address - Phone:830-249-9995
Practice Address - Fax:830-249-9868
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8182207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150072003Medicaid
TX150072001Medicaid
TX8G2429OtherBCBS
TX930115328Medicare PIN
TXG61587Medicare UPIN
TX150072003Medicaid