Individual
MR. GREGORY J WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N 500 W STE 111, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
050147
AZ
207N00000X
Dermatology Physician
13269871-1205
UT
207N00000X
Dermatology Physician
50147
AZ
207ND0900X
Dermatopathology Physician
050147
AZ
207ND0900X
Dermatopathology Physician
Primary
13269871-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
238919
—
AZ
Enumeration date
06/21/2010
Last updated
08/03/2023
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