Provider Demographics
NPI:1356402986
Name:HOUGH, GREGORY HUNTER (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HUNTER
Last Name:HOUGH
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 1:18132 MISTY FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8528
Mailing Address - Country:US
Mailing Address - Phone:907-726-1479
Mailing Address - Fax:
Practice Address - Street 1:18132 MISTY FALLS CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8528
Practice Address - Country:US
Practice Address - Phone:907-726-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6609208600000X
IN1188144208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK162469OtherMEDICARE PTAN
AKMD0986Medicaid