Provider Demographics
NPI:1699889972
Name:BROPHEY, GREGORY JASON (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JASON
Last Name:BROPHEY
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 1:7 JOHN STARK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486-4909
Mailing Address - Country:US
Mailing Address - Phone:802-372-3188
Mailing Address - Fax:802-527-0797
Practice Address - Street 1:156 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-8501
Practice Address - Country:US
Practice Address - Phone:802-527-7787
Practice Address - Fax:802-527-0797
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1699889972OtherNPI
I46670Medicare UPIN
BR4174501Medicare ID - Type Unspecified