Provider Demographics
NPI:1801811534
Name:GREGORY, THEODORE KNOX II (CRNA)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:KNOX
Last Name:GREGORY
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:719 W COKE ROAD
Practice Address - Street 2:PRESBYTERIAN HOSPITAL WINNSBORO
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494
Practice Address - Country:US
Practice Address - Phone:903-342-5227
Practice Address - Fax:903-342-4121
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX049529367500000X
TXRN628107367500000X
TXAP108509367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002294902Medicaid
TX85064UOtherBLUE CROSS BLUE SHIELD