Individual
DR. GREGORY A. GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E CARPENTER ST, DEPARTMENT OF RADIOLOGY, SPRINGFIELD, IL 62702-5324
(217) 544-6464
(217) 525-5671
Mailing address
611 N 6TH ST, SPRINGFIELD, IL 62702-5327
(217) 544-2149
(217) 544-9553
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036064294
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300026227
RR MEDICARE
IL
05
—
36064294
—
IL
01
—
P00028349
RR MEDICARE
IL
Enumeration date
08/16/2006
Last updated
01/11/2024
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