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Individual
STACY GREGORY
Active
Individual
STACY GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
096694
OH
207L00000X
Anesthesiology Physician
39354
KY
207L00000X
Anesthesiology Physician
Primary
P9358
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000635467
ANTHEM
IN
01
—
107356
SIHO
IN
01
—
129703800
US DEPT OF LABOR
—
05
—
3145019
—
OH
05
—
339125201
—
TX
01
—
3730868000
PASSPORT ADVANTAGE
—
01
—
50025230
PASSPORT
—
01
—
8ER269
BCBS
TX
01
—
GR4317491
MEDICARE
—
01
—
P01444554
RR MEDICARE
TX
Enumeration date
05/15/2006
Last updated
02/27/2017
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