Provider Demographics
NPI:1639516255
Name:GOSEY, GREGORY MAXWELL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MAXWELL
Last Name:GOSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:GOSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:115 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5110
Mailing Address - Country:US
Mailing Address - Phone:575-622-7600
Mailing Address - Fax:
Practice Address - Street 1:320 WARNER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4441
Practice Address - Country:US
Practice Address - Phone:208-743-3523
Practice Address - Fax:833-941-3874
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP315207X00000X
RIMD18516207X00000X, 207XX0004X
NMMD2024-0348207X00000X
IDM-17333207X00000X, 207XX0004X
CAA132443207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2024-0348OtherNM LICENSE
A132443OtherCALIFORNIA MEDICAL LICENSE NUMBER