Provider Demographics
NPI:1114094273
Name:ANGIER, GREGGORY N (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGGORY
Middle Name:N
Last Name:ANGIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1920 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4619
Practice Address - Country:US
Practice Address - Phone:903-792-6114
Practice Address - Fax:903-792-7876
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010163372086S0127X, 208600000X
TXN42502086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO020049107OtherRAILROAD MEDICARE
MO431560263006OtherTRICARE
OK200695820AMedicaid
MO205327109Medicaid
MO431560263006OtherTRICARE
MO205327109Medicaid