Provider Demographics
NPI:1114925229
Name:MISENHIMER, GREGORY ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ROBERT
Last Name:MISENHIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 MURCHISON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2921
Mailing Address - Country:US
Mailing Address - Phone:915-595-1099
Mailing Address - Fax:915-595-2933
Practice Address - Street 1:1720 MURCHISON
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2921
Practice Address - Country:US
Practice Address - Phone:915-534-7465
Practice Address - Fax:915-534-1289
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3614207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120130301Medicaid
TX120130301Medicaid
TX8K2086Medicare PIN