Provider Demographics
NPI:1437520756
Name:GREGORY, GEORGE II
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GREGORY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOSPITAL LOOP NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2115
Mailing Address - Country:US
Mailing Address - Phone:505-348-8247
Mailing Address - Fax:
Practice Address - Street 1:103 HOSPITAL LOOP NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2115
Practice Address - Country:US
Practice Address - Phone:505-348-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3376314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility