Provider Demographics
NPI:1285621664
Name:GREGORY, JOHN REEVES (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REEVES
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 COWHORN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9766
Mailing Address - Country:US
Mailing Address - Phone:903-614-3000
Mailing Address - Fax:903-614-3525
Practice Address - Street 1:5002 COWHORN CREEK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-9766
Practice Address - Country:US
Practice Address - Phone:903-614-3000
Practice Address - Fax:903-614-3525
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2379174400000X
ARR3021174400000X
LAL#014100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAL#014100OtherLOUISIANA MEDICAL LICENSE
TX40048923OtherTEXAS CONTROLLED SUB. LIC
TXG2379OtherTX STATE MEDICAL LICENSE
TX114062601Medicaid
ARR-3021OtherARKANSAS MEDICAL LICENSE
AR103414001Medicaid
OK19284OtherOKLAHOMA MEDICAL LICENSE
OK19284OtherOKLAHOMA MEDICAL LICENSE
OK19284OtherOKLAHOMA MEDICAL LICENSE
AG1777816OtherDEA NUMBER
TX40048923OtherTEXAS CONTROLLED SUB. LIC