Provider Demographics
NPI:1184624975
Name:DENSMORE, GREGG S (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:S
Last Name:DENSMORE
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 1:700 SUNSET DR
Mailing Address - Street 2:STE F
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1260
Mailing Address - Country:US
Mailing Address - Phone:541-963-8578
Mailing Address - Fax:541-963-8932
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:STE F
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1260
Practice Address - Country:US
Practice Address - Phone:541-963-8578
Practice Address - Fax:541-963-8932
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18510207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057724Medicaid
WA057724OtherDEPT LABOR & INDUSTRIES
E25025Medicare UPIN
OR057724Medicaid
0663210001Medicare NSC