Provider Demographics
NPI:1871581512
Name:GREGSTON, JAY LANCE (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:LANCE
Last Name:GREGSTON
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 1:2004 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1460
Mailing Address - Country:US
Mailing Address - Phone:580-252-1911
Mailing Address - Fax:580-252-5102
Practice Address - Street 1:2004 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1460
Practice Address - Country:US
Practice Address - Phone:580-252-1911
Practice Address - Fax:580-252-1020
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20226207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100254370AMedicaid
OK200069940AMedicaid
OK200116880BMedicaid
OK100254370BMedicaid
OK200116880AMedicaid
OK100254370BMedicaid
OK100254370BMedicaid
OK24M0804901Medicare PIN
OKM00522255Medicare PIN
OK200116880BMedicaid
OK200116880AMedicaid
OK800522488Medicare PIN