Provider Demographics
NPI:1942250188
Name:VALENZUELA, GREGG A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-288-7901
Practice Address - Fax:804-273-9167
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101036504207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5857449Medicaid
VA5857449Medicaid
VAD93653Medicare UPIN