Provider Demographics
NPI:1518944552
Name:GREGORY, JAMES FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANKLIN
Last Name:GREGORY
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 1:510 FULLERTON RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2970
Mailing Address - Country:US
Mailing Address - Phone:618-233-7666
Mailing Address - Fax:618-233-7461
Practice Address - Street 1:510 FULLERTON RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2970
Practice Address - Country:US
Practice Address - Phone:618-233-7666
Practice Address - Fax:618-233-7461
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL128234OtherBCBS OF MO
ILC37072Medicare UPIN