Provider Demographics
NPI:1760454235
Name:FLURY, GREGORY ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:FLURY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 YELLOWSTONE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9311
Mailing Address - Country:US
Mailing Address - Phone:307-578-2903
Mailing Address - Fax:307-578-2937
Practice Address - Street 1:424 YELLOWSTONE AVE STE 120
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9311
Practice Address - Country:US
Practice Address - Phone:307-578-2903
Practice Address - Fax:307-578-2937
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2028363A00000X
GA4149363AS0400X
WYPA1009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4149OtherPA LICENSE
WYPA1009OtherSTATE PA LICENSE