Provider Demographics
NPI:1821231291
Name:ANITA K. GREGORY, M.D. APC
Entity Type:Organization
Organization Name:ANITA K. GREGORY, M.D. APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-8300
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4304
Mailing Address - Country:US
Mailing Address - Phone:714-835-8300
Mailing Address - Fax:714-835-8304
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:714-835-8300
Practice Address - Fax:714-835-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G74192332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74192OtherSTATE LICENSE
CAG74192OtherSTATE LICENSE
CAG52876Medicare UPIN