MEDICARE: GREGORY M STIRNEMAN DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1312	TX

General Provider Information

NPI Number	:	1295919538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY M STIRNEMAN DPM PA

Provider Business Mailing Address
First Line	:	2011 S JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-5821
Country	:	US
Telephone Number	:	903-586-7979
Fax Number	:	903-589-0487

Provider Business Practice Location Address
First Line	:	2011 S JACKSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-5821
Country	:	US
Telephone Number	:	903-586-7979
Fax Number	:	903-589-0487

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. PHYLESA LASITER
Credential	:
Telephone Number	:	903-586-7979

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	12/26/2012

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