Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 13585 | OK |
Y | 208600000X | Surgeon | 13585 | OK |
NPI | 1013051226 |
---|---|
Provider Name | Jay Allen Gregory |
First Address | Muskogee, OK 74401-4937 |
Second Address | Muskogee, OK 74401-4937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |