Provider Demographics
NPI:1194785097
Name:MCGREGOR, TAMARA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNNE
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:MCGREGOR
Other - Last Name:PRIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-1399
Mailing Address - Fax:214-648-1307
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-1399
Practice Address - Fax:214-648-1307
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1544207QA0505X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034939103Medicaid
TX8D0460Medicare ID - Type Unspecified
TX8L24483Medicare PIN
TX034939103Medicaid