Provider Demographics
NPI:1508104449
Name:GREGORY, LAYLA DENISE
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:DENISE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 FACULTY DR
Mailing Address - Street 2:STE 1N207
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-1805
Mailing Address - Country:US
Mailing Address - Phone:719-333-5950
Mailing Address - Fax:
Practice Address - Street 1:2355 FACULTY DR
Practice Address - Street 2:STE 1N207
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-1805
Practice Address - Country:US
Practice Address - Phone:719-333-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians