Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 18763 | TX |
NPI | 1053316877 |
---|---|
Provider Name | Dr. J. Gregory Condrey |
First Address | Sugar Land, TX 77478-4914 |
Second Address | Sugar Land, TX 77478-4914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |