Provider Demographics
NPI:1518037217
Name:GREGOR, ROBERT ALFRED JR (DNP, CRNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALFRED
Last Name:GREGOR
Suffix:JR
Gender:M
Credentials:DNP, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SMITHS POND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-3065
Mailing Address - Country:US
Mailing Address - Phone:570-550-6478
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:570-819-5186
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN528411L163WG0000X
PASP008341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021027250002Medicaid
PA1021027280001Medicaid
PA1021027250002Medicaid