1154328052 NPI number — DR. DONALD J GREGGAIN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154328052 NPI number — DR. DONALD J GREGGAIN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GREGGAIN

Provider First Name:

DONALD

Provider Middle Name:

J

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1154328052

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/26/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

415 6TH STREET

Provider Second Line Business Mailing Address:

ATTN: PHYSICIAN SERVICES

Provider Business Mailing Address City Name:

LEWISTON

Provider Business Mailing Address State Name:

ID

Provider Business Mailing Address Postal Code:

83501-2434

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

208-750-7462

Provider Business Mailing Address Fax Number:

208-750-7467

Provider First Line Business Practice Location Address:

415 6TH ST STE 3C

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LEWISTON

Provider Business Practice Location Address State Name:

ID

Provider Business Practice Location Address Postal Code:

83501-2431

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

208-750-3840

Provider Business Practice Location Address Fax Number:

208-750-3839

Provider Enumeration Date:

07/07/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  32331 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: M-6680 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000010001249 . This is a "REGENCE BLUE SHIELD PROV" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: 080075556 . This is a "RAILROAD MEDICARE PROV#" identifier . This identifiers is of the category "OTHER".
• Identifier: 1003592 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1139282 . This is a "IDAHO MEDICARE PROV #" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: 193254001 . This is a "OWCP PROV #" identifier . This identifiers is of the category "OTHER".
• Identifier: 1095264 . This is a "WASH MEDICAID PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 71993 8J935 . This is a "BLUE CROSS IDAHO PROV#" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: 104012 . This is a "DL&I PROV NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1154328052 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
• Identifier: 003310000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".