Healthcare Provider Details

I. General information

NPI: 1831162262
Provider Name (Legal Business Name): GREGORY PAUL PISARSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 OAK DR SOUTH STE J
LAKE JACKSON TX
77566
US

IV. Provider business mailing address

504 THIS WAY ST STE C
LAKE JACKSON TX
77566-5155
US

V. Phone/Fax

Practice location:
  • Phone: 979-297-9289
  • Fax: 979-299-1007
Mailing address:
  • Phone: 979-297-9289
  • Fax: 979-299-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberH9253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: