1417995200 NPI number — DR. GALE GREGORY-LAINE D.O.

Table of content: DR. GALE GREGORY-LAINE D.O. (NPI 1417995200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417995200 NPI number — DR. GALE GREGORY-LAINE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGORY-LAINE
Provider First Name:
GALE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1417995200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1421 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-249-9995
Provider Business Mailing Address Fax Number:
830-249-9868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1421 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-249-9995
Provider Business Practice Location Address Fax Number:
830-249-9868
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  K8182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150072003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150072001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G2429 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com