Provider Demographics
NPI:1548278617
Name:GREGORY, MAURICE DUBOIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:DUBOIS
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAURICE
Other - Middle Name:D
Other - Last Name:GREGORY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:3395 S JONES BLVD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6729
Mailing Address - Country:US
Mailing Address - Phone:702-822-1356
Mailing Address - Fax:702-877-1706
Practice Address - Street 1:2020 GOLDRING AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4000
Practice Address - Country:US
Practice Address - Phone:702-822-1356
Practice Address - Fax:702-877-1706
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4894208D00000X, 207QA0401X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880467230OtherCORP TAX ID NUMBER OR EIN
NVVMD4894Medicare ID - Type Unspecified
NVC96280Medicare UPIN