Provider Demographics
NPI:1720116924
Name:MCCORD, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:MCCORD
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 5068
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5068
Mailing Address - Country:US
Mailing Address - Phone:812-842-2701
Mailing Address - Fax:812-842-2717
Practice Address - Street 1:4133 GATEWAY BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7953
Practice Address - Country:US
Practice Address - Phone:812-842-2701
Practice Address - Fax:812-842-2717
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038295207RG0100X
KY50053207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100180010AMedicaid
534650AMedicare ID - Type Unspecified
IN100180010AMedicaid