Provider Demographics
NPI:1386731990
Name:GREGORY, DARIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DARIN
Middle Name:MICHAEL
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:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-717-4377
Mailing Address - Fax:402-717-4317
Practice Address - Street 1:13808 W MAPLE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-6231
Practice Address - Country:US
Practice Address - Phone:402-493-8200
Practice Address - Fax:402-493-1482
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
476000549002OtherMUTUAL OF OMAHA
NE04027OtherBLUE CROSS BLUE SHIELD
NEH7600054901Medicaid
NE04027OtherBLUE CROSS BLUE SHIELD
277027Medicare ID - Type Unspecified