Provider Demographics
NPI:1972739357
Name:BANCROFT, GREGORY NELSON (MD PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NELSON
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 TEXAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-313-0540
Mailing Address - Fax:281-313-0542
Practice Address - Street 1:2171 TEXAS DRIVE
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-313-0540
Practice Address - Fax:281-313-0542
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1992208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CK358OtherBCBS IND. NUMBER
TXTXB106790Medicare PIN
TX8CK358OtherBCBS IND. NUMBER