Individual
CHARLES C GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO PA
Contact information
Practice address
311B BUDDY GANEM, PORTLAND, TX 78374-3233
(361) 643-9800
(361) 643-5112
Mailing address
PO BOX 903, PORTLAND, TX 78374-0903
(361) 643-9800
(361) 643-5112
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
L7737
TX
207Q00000X
Family Medicine Physician
Primary
L7737
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178461302
—
TX
01
—
8U3260
INDIVIDUAL BCBS
TX
Enumeration date
06/29/2006
Last updated
06/14/2024
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