Provider Demographics
NPI:1255397790
Name:GREGORY, PAUL F (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:GREGORY
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:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-469-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26660Medicaid
AZZ114182Medicare PIN
AZ26660Medicaid
AZZ76021Medicare PIN