Provider Demographics
NPI:1518958842
Name:MINCEY, GREGORY JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JULIAN
Last Name:MINCEY
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 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-3625
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13516207W00000X
NC0026851207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH2000325OtherFIRSTCAROLINACARE
NC180020412OtherRAILROAD MEDICARE
NC232483OtherMAMSI
NC59512OtherBLUE CROSS BLUE SHIELD
NC8959512Medicaid
NC0838886OtherUNITED HEALTHCARE
SCN00509Medicaid
NC43011OtherMEDCOST
NCFH2000325OtherFIRSTCAROLINACARE
NC208907Medicare PIN