Provider Demographics
NPI:1609803006
Name:EADS, GREGORY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:EADS
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 1:1120 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3242
Mailing Address - Country:US
Mailing Address - Phone:832-813-0979
Mailing Address - Fax:832-813-0984
Practice Address - Street 1:1120 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3242
Practice Address - Country:US
Practice Address - Phone:832-813-0979
Practice Address - Fax:832-813-0984
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049545207V00000X
TXM4048207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092612000Medicaid
TX184714701Medicaid
VA006231250Medicaid
TXP00385879OtherMEDICARE RAILROAD PTAN
TXP00385879OtherMEDICARE RAILROAD PTAN
TX8J3426Medicare PIN
TXD58812Medicare UPIN
TX184714701Medicaid