Provider Demographics
NPI:1902146707
Name:GREGORY, JENNIFER FERN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FERN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:3459 OLD HALIFAX RD STE I
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4900
Practice Address - Country:US
Practice Address - Phone:434-549-0383
Practice Address - Fax:434-549-0384
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2022-11-15
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Provider Licenses
StateLicense IDTaxonomies
VA0101256718207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology