Organization
CHARLES GREGORY, DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GREGORY D.O. (OWNER)
(361) 643-9800
Entity
Organization
Contact information
Practice address
1500 WILDCAT DR STE C, PORTLAND, TX 78374-2826
(361) 643-9800
(361) 643-5112
Mailing address
1500 WILDCAT DR STE C, PORTLAND, TX 78374-2826
(361) 643-9800
(361) 643-5112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L7737
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037MY
BCBS TX GROUP
TX
05
—
179568401
—
TX
Enumeration date
03/29/2007
Last updated
04/19/2025
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