Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D9361 | MN |
NPI | 1023194107 |
---|---|
Provider Name | Dr. Gregory Gayle Lecy |
First Address | Marshall, MN 56258-2645 |
Second Address | Marshall, MN 56258-2645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |