Provider Demographics
NPI:1881655868
Name:GREGORY, ANITA KAY (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:KAY
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74192208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G741920OtherBLUE SHIELD
CA00G741920OtherBLUE SHIELD
CAG74192Medicare ID - Type Unspecified