Basic Information
| Provider Information | |||||||||
| NPI: | 1841268521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZYCH | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1904 GRANT AVE | ||||||||
| Address2: | STE G | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724016165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314255752 | ||||||||
| FaxNumber: | 7314225743 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W FOREST AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314220305 | ||||||||
| FaxNumber: | 7314220357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0102204735 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 04449 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | DO1484 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 036151389 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | DR.0043812 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 21337 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | E8994 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3307407 | 05 | TN | MEDICAID | 7100407180 | 05 | KY | MEDICAID | 04205019 | 05 | MS | MEDICAID |