Provider Demographics
NPI:1669479861
Name:ELDERS, GREGORY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAY
Last Name:ELDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:508 MEDICAL CENTER BLVD # 360
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2953
Mailing Address - Country:US
Mailing Address - Phone:936-756-2229
Mailing Address - Fax:844-274-2115
Practice Address - Street 1:508 MEDICAL CENTER BLVD # 360
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2953
Practice Address - Country:US
Practice Address - Phone:936-756-2229
Practice Address - Fax:844-274-2115
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8677207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167432705Medicaid
TXL8677OtherLICENSE
TX277632ZH6HMedicare PIN