Provider Demographics
NPI:1043269616
Name:READ, GREG (CRNA)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 VINTAGE LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4550
Mailing Address - Country:US
Mailing Address - Phone:970-625-0509
Mailing Address - Fax:
Practice Address - Street 1:1607 VINTAGE LN
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4550
Practice Address - Country:US
Practice Address - Phone:970-625-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO710708367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42702577Medicaid
COC802975Medicare PIN
CO42702577Medicaid
COC805364Medicare PIN