Provider Demographics
NPI:1730678392
Name:GREGERSON, ANDREA ANN BUCCI (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANN BUCCI
Last Name:GREGERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6011 E WOODMEN RD STE 125
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2603
Mailing Address - Country:US
Mailing Address - Phone:719-571-8030
Mailing Address - Fax:719-571-8031
Practice Address - Street 1:6011 E WOODMEN RD STE 125
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2603
Practice Address - Country:US
Practice Address - Phone:719-571-8030
Practice Address - Fax:719-571-8031
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7481207Q00000X
CODR.0068051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine