Provider Demographics
NPI:1588650741
Name:DOAK, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:DOAK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 E 14TH ST
Mailing Address - Street 2:PO BOX 1706
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5972
Mailing Address - Country:US
Mailing Address - Phone:660-827-9407
Mailing Address - Fax:660-827-3742
Practice Address - Street 1:3700 W 10TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-827-2730
Practice Address - Fax:660-827-2731
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2014-12-23
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Provider Licenses
StateLicense IDTaxonomies
MOR5C46207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588650741Medicaid
MO1588650741Medicaid