Provider Demographics
NPI:1851382923
Name:GREGG, FREDERICK P (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:P
Last Name:GREGG
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:PO BOX 4346
Mailing Address - Street 2:DEPT 808
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:713-331-1850
Mailing Address - Fax:713-521-7710
Practice Address - Street 1:12951 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1923
Practice Address - Country:US
Practice Address - Phone:713-526-5771
Practice Address - Fax:713-526-2036
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD70622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134675102Medicaid
TX134675111Medicaid
TX134675108Medicaid
TX134675110Medicaid
TX134675112Medicaid
83R198Medicare ID - Type Unspecified
480334YKTVMedicare PIN
D49645Medicare UPIN
8A3995Medicare ID - Type Unspecified
TX134675111Medicaid
TX134675112Medicaid