Provider Demographics
NPI:1255535464
Name:GREGG M ANIGIAN MD PA
Entity type:Organization
Organization Name:GREGG M ANIGIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-0006
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:#108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-369-0006
Mailing Address - Fax:214-369-0190
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:#108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-369-0006
Practice Address - Fax:214-369-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7116208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G36MMedicare PIN
TXC71223Medicare UPIN
TXTXB111185Medicare PIN