Provider Demographics
NPI:1457496705
Name:MOORE, GREGORY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANTHONY
Last Name:MOORE
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 1:74B CENTENNIAL LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7918
Mailing Address - Country:US
Mailing Address - Phone:541-686-3791
Mailing Address - Fax:541-686-3795
Practice Address - Street 1:74B CENTENNIAL LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7918
Practice Address - Country:US
Practice Address - Phone:541-686-3791
Practice Address - Fax:541-686-3795
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28629208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500601851Medicaid
OR500601851Medicaid