Provider Demographics
NPI:1831496306
Name:MAURICE D GREGORY JR M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MAURICE D GREGORY JR M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:DUBOIS
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-822-1356
Mailing Address - Street 1:3395 S JONES BLVD
Mailing Address - Street 2:SUITE# 132
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6729
Mailing Address - Country:US
Mailing Address - Phone:702-822-1356
Mailing Address - Fax:702-877-1706
Practice Address - Street 1:2020 GOLDRING AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4000
Practice Address - Country:US
Practice Address - Phone:702-822-1356
Practice Address - Fax:702-877-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4894208D00000X, 208VP0000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty