Provider Demographics
NPI:1811936982
Name:ALBAUGH, GREGORY K (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:ALBAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 N VENTURA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2213
Mailing Address - Country:US
Mailing Address - Phone:805-983-6233
Mailing Address - Fax:805-983-2459
Practice Address - Street 1:2841 N VENTURA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2213
Practice Address - Country:US
Practice Address - Phone:805-983-6233
Practice Address - Fax:805-983-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A87602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08582ZOtherBLUE SHIELD
CA77-0079544OtherBLUE CROSS
CAGR0098310Medicaid
CAP00224835OtherRR MEDICARE
CAW20A8760BMedicare PIN
CAI14882Medicare UPIN
CAW20A8760AMedicare PIN