Provider Demographics
NPI:1861598534
Name:LAWS, GREGG L (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:L
Last Name:LAWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1430
Mailing Address - Country:US
Mailing Address - Phone:217-854-4552
Mailing Address - Fax:217-854-5204
Practice Address - Street 1:1115 MORGAN ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1430
Practice Address - Country:US
Practice Address - Phone:217-854-4552
Practice Address - Fax:217-854-5204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063415Medicaid
C43578Medicare UPIN
IL758931Medicare PIN