Provider Demographics
NPI: | 1821441486 |
---|---|
Name: | MESSENGER, GREGORY SCOTT (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | GREGORY |
Middle Name: | SCOTT |
Last Name: | MESSENGER |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1515 LAKE LANSING RD STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | LANSING |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48912-3752 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 517-487-0128 |
Mailing Address - Fax: | 517-487-2639 |
Practice Address - Street 1: | 1515 LAKE LANSING RD STE A |
Practice Address - Street 2: | |
Practice Address - City: | LANSING |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48912-3752 |
Practice Address - Country: | US |
Practice Address - Phone: | 517-487-0128 |
Practice Address - Fax: | 517-487-2639 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-07-19 |
Last Update Date: | 2020-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301501765 | 207N00000X, 207ND0101X, 207NI0002X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | |
No | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No | 207NI0002X | Allopathic & Osteopathic Physicians | Dermatology | Clinical & Laboratory Dermatological Immunology |