Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS003093L | PA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS003093L | PA |
NPI | 1194721563 |
---|---|
Provider Name | Dr. Thomas Richard Degregory |
First Address | Delmont, PA 15626-1005 |
Second Address | Greensburg, PA 15601-9769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008385760004 | (05) | PA |
B36408 | (02) | PA |