Healthcare Provider Details

I. General information

NPI: 1831255298
Provider Name (Legal Business Name): GREGORY S. REMIEN P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 UNIVERSITY DR E STE 100
BRYAN TX
77802
US

IV. Provider business mailing address

3121 UNIVERSITY DR E STE 100
BRYAN TX
77802-3473
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-0169
  • Fax: 979-776-1372
Mailing address:
  • Phone: 979-776-0169
  • Fax: 979-776-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004798
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10004798
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: