Individual
DR. LAWRENCE J GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 E 21ST ST, TULSA, OK 74114-1409
(918) 749-2261
(918) 749-8712
Mailing address
PO BOX 52588, TULSA, OK 74152-0588
(918) 749-2261
(918) 749-8712
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9455
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070004141
RAILROAD MEDICARE
—
05
—
100116590A
—
OK
01
—
4053536
AETNA PPO
—
01
—
730776171002
BLUE CROSS BLUE SHIELD
—
01
—
876735
AETNA HMO
—
01
—
9455
MEDICAL LICENSE NUMBER
OK
Enumeration date
09/26/2005
Last updated
05/16/2008
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