Healthcare Provider Details

I. General information

NPI: 1801892393
Provider Name (Legal Business Name): GREGORY G PINEGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

921 OKLAHOMA BLVD
ALVA OK
73717-2627
US

IV. Provider business mailing address

921 OKLAHOMA BLVD
ALVA OK
73717-2627
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-0091
  • Fax: 580-327-0093
Mailing address:
  • Phone: 580-327-0091
  • Fax: 580-327-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17680
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: