Individual
DR. CHESLEY LELWYNN GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. ,O.D.
Contact information
Practice address
9425 HEALTHPLEX DR STE 101, SHREVEPORT, LA 71106-8154
(318) 683-5171
(318) 683-5182
Mailing address
9425 HEALTHPLEX DR STE 101, SHREVEPORT, LA 71106-8154
(318) 683-5171
(318) 683-5182
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
765-002T
LA
207P00000X
Emergency Medicine Physician
202699
LA
207Q00000X
Family Medicine Physician
Primary
202699
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1150631
—
LA
01
—
1578240
MEDICAID (TIE BREAKER TAXONOMY 207Q00000X)
LA
05
—
1578240
—
LA
Enumeration date
07/18/2006
Last updated
12/03/2019
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