Provider Demographics
NPI:1851381388
Name:GREGORY, GAYLE L (MD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:L
Other - Last Name:ROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15801 E DON CARLOS DR
Mailing Address - Street 2:PO BOX 26485
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-4109
Mailing Address - Country:US
Mailing Address - Phone:602-335-2000
Mailing Address - Fax:602-476-2077
Practice Address - Street 1:15801 E DON CARLOS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-4109
Practice Address - Country:US
Practice Address - Phone:602-335-2000
Practice Address - Fax:602-476-2077
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ304402084P0800X, 2084P0804X
IDM-119002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ707705Medicaid
AZ72394Medicare PIN
AZ707705Medicaid