Provider Demographics
NPI:1457324329
Name:MCADOO, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:MCADOO
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 1:1333 W 5TH ST, STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-2522
Mailing Address - Fax:307-672-3732
Practice Address - Street 1:1333 W 5TH ST, STE 210
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-672-2522
Practice Address - Fax:307-672-3732
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4825207V00000X
WY6568A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY6568AOtherWYOMING STATE LICENSE
SD6200880Medicaid
WY1629182019Medicaid
1457324329OtherNPI
SDG63047Medicare UPIN
SD7737Medicare ID - Type Unspecified
1457324329OtherNPI