Provider Demographics
NPI:1255373148
Name:MARKWAY, GREGORY (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:MARKWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BOONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0903
Mailing Address - Country:US
Mailing Address - Phone:573-636-3066
Mailing Address - Fax:573-761-6888
Practice Address - Street 1:3702 W TRUMAN BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4970
Practice Address - Country:US
Practice Address - Phone:573-634-5303
Practice Address - Fax:573-761-6888
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR00856Medicare UPIN