Provider Demographics
NPI:1699761106
Name:PRICE, GREGORY D SR (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:PRICE
Suffix:SR
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 1:215 MEDICAL PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5355
Mailing Address - Country:US
Mailing Address - Phone:334-222-4327
Mailing Address - Fax:334-222-4333
Practice Address - Street 1:215 MEDICAL PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5355
Practice Address - Country:US
Practice Address - Phone:334-222-4327
Practice Address - Fax:334-222-4333
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1846890-1205207RC0000X
AL14470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011769Medicare ID - Type UnspecifiedMEDICARE
UT000060807Medicare PIN
UTE40078Medicare UPIN