Provider Demographics
NPI:1699774869
Name:GREGORY, JOHNASAN M (MD)
Entity type:Individual
Prefix:
First Name:JOHNASAN
Middle Name:M
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 1:300 N HIGHLAND AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7392
Mailing Address - Country:US
Mailing Address - Phone:903-957-0233
Mailing Address - Fax:903-957-0263
Practice Address - Street 1:300 N HIGHLAND AVE STE 340
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7392
Practice Address - Country:US
Practice Address - Phone:903-957-0233
Practice Address - Fax:903-957-0263
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8150174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126499603Medicaid
TXG8150OtherLICENSE
TX126499603Medicaid
TXTXB146501Medicare PIN
TXE04559Medicare UPIN
TXTXB146500Medicare PIN
TXTXB146499Medicare PIN