Provider Demographics
NPI:1770523656
Name:DESILVA, GREGORY LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEWIS
Last Name:DESILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 245064
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-4024
Mailing Address - Fax:520-626-2668
Practice Address - Street 1:707 N ALVERNON WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1827
Practice Address - Country:US
Practice Address - Phone:520-626-4024
Practice Address - Fax:520-626-2668
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064231207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery