Provider Demographics
NPI:1992778377
Name:GREGORY, JASON R (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SAINT MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1442
Mailing Address - Country:US
Mailing Address - Phone:803-682-0344
Mailing Address - Fax:
Practice Address - Street 1:3000 ST. MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-454-2613
Practice Address - Fax:803-765-1732
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC901207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009010Medicaid
SC576008010002OtherTRICARE
SC576008010010OtherBCBS
SC7535722OtherAETNA
SC576008010007OtherBLUE CHOICE
SC6958751OtherCIGNA
SCP00369661Medicare PIN
SC6958751OtherCIGNA
SC576008010002OtherTRICARE
SC576008010010OtherBCBS