Basic Information
| Provider Information | |||||||||
| NPI: | 1134289390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGG | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1648 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974401648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416874900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1007 HARLOW RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974777126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417410387 | ||||||||
| FaxNumber: | 5414632820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 47924 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 036-130301 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | MD197461 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 116417100 | 05 | MN | MEDICAID |