Individual
DR. GARY NED GREGERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 12TH AVE RD, SUITE A, NAMPA, ID 83686-7715
(208) 468-9400
(208) 468-9447
Mailing address
1611 12TH AVE RD, SUITE A, NAMPA, ID 83686-7715
(208) 468-9400
(208) 468-9447
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6312
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002364200
—
ID
Enumeration date
06/03/2006
Last updated
07/08/2007
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