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NPI Code Detail

MEDICARE: DR. GREGORY PAUL WITTPENN M.D.

MEDICARE: DR. GREGORY PAUL WITTPENN M.D.
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
12082S0105XSurgery of the Hand (Plastic Surgery) PhysicianH8896TX
22086S0122XPlastic and Reconstructive Surgery PhysicianH8896TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14470780OTHERTXAETNA PIN
20070LYOTHERTXBLUE CROSS PROVIDER #
33324976OTHERTXREDILINK BLUE #
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326007303
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY PAUL WITTPENN M.D.
Provider Business Mailing Address
First Line : 3616 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2539
Country : US
Telephone Number : 936-564-3744
Fax Number : 936-564-0642
Provider Business Practice Location Address
First Line : 3616 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2539
Country : US
Telephone Number : 936-564-3744
Fax Number : 936-564-0642
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2006
Last Update Date : 04/10/2024

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