Provider Demographics
NPI:1497752877
Name:DAVIS, GREGORY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LYNN
Last Name:DAVIS
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 1:1040 MANGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3509
Mailing Address - Country:US
Mailing Address - Phone:530-345-0064
Mailing Address - Fax:530-345-0680
Practice Address - Street 1:1040 MANGROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3509
Practice Address - Country:US
Practice Address - Phone:530-345-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73638207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G736380Medicaid
CA00G736380Medicaid
CA00G736380Medicare ID - Type Unspecified