Provider Demographics
NPI:1477865822
Name:WINN GREGORY, M.D., P.C.
Entity Type:Organization
Organization Name:WINN GREGORY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WINN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-667-2420
Mailing Address - Street 1:600 NW 11TH ST STE E10
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8602
Mailing Address - Country:US
Mailing Address - Phone:541-667-2420
Mailing Address - Fax:541-667-2421
Practice Address - Street 1:600 NW 11TH ST STE E10
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8602
Practice Address - Country:US
Practice Address - Phone:541-667-2420
Practice Address - Fax:541-667-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082300000OtherBLUE CROSS BLUE SHIELD
OR288051Medicaid
020050466OtherRAILROAD MEDICARE
WA0161303Medicaid
ORA01638Medicare UPIN
OR109610Medicare PIN