Provider Demographics
NPI:1760685580
Name:GREGG, TAMMY R (DO)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:R
Last Name:GREGG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:128 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2290
Mailing Address - Country:US
Mailing Address - Phone:719-589-5161
Mailing Address - Fax:
Practice Address - Street 1:1710 1ST ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2302
Practice Address - Country:US
Practice Address - Phone:719-589-3658
Practice Address - Fax:719-589-3650
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67086357Medicaid
CO300595Medicare PIN