Provider Demographics
NPI:1952392078
Name:GREGG, CLINT WALKER (MD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:WALKER
Last Name:GREGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:4505 82ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3215
Practice Address - Country:US
Practice Address - Phone:806-798-7244
Practice Address - Fax:806-798-3391
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4169207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100140800AMedicaid
TX114027100Medicaid
TX137622006Medicaid
TX137622007Medicaid
NMW5079Medicaid
NMA005OtherTRIWEST
TX114027101OtherFIRSTCARE COMMERCIAL
NM33853OtherPRESBYTERIAN COMMERCIAL
NM33853Medicaid
TX82W450OtherBC/BS
TX80784ZOtherHMO BLUE
TX82W450Medicare PIN
NM33853OtherPRESBYTERIAN COMMERCIAL
TX80784ZOtherHMO BLUE