Provider Demographics
NPI:1861454910
Name:GREGORY, REUEL M (DO)
Entity Type:Individual
Prefix:
First Name:REUEL
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2229
Mailing Address - Country:US
Mailing Address - Phone:816-776-2201
Mailing Address - Fax:816-480-4515
Practice Address - Street 1:902 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2229
Practice Address - Country:US
Practice Address - Phone:816-776-2201
Practice Address - Fax:816-480-4515
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010862207P00000X, 207Q00000X
MO20012010862207P00000X
MO2001201862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54472Medicare UPIN
H54472Medicare UPIN