Provider Demographics
NPI:1366627499
Name:GREGORY P. WITTPENN, MD PA
Entity Type:Organization
Organization Name:GREGORY P. WITTPENN, MD PA
Other - Org Name:NEW HORIZONS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WITTPENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-564-3744
Mailing Address - Street 1:3616 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2539
Mailing Address - Country:US
Mailing Address - Phone:936-564-3744
Mailing Address - Fax:
Practice Address - Street 1:3616 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2539
Practice Address - Country:US
Practice Address - Phone:936-564-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173182001Medicaid
TX007OLYOtherBLUE CROSS BLUE SHIELD
TX007OLYOtherBLUE CROSS BLUE SHIELD
TX00258YMedicare PIN