Provider Demographics
NPI:1639176563
Name:PFISTER, GREGORY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:PFISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1950 SAINT CHARLES ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9172
Mailing Address - Country:US
Mailing Address - Phone:812-482-9555
Mailing Address - Fax:812-482-9073
Practice Address - Street 1:1950 SAINT CHARLES ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9172
Practice Address - Country:US
Practice Address - Phone:812-482-9555
Practice Address - Fax:812-482-9073
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01046232A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200174200AMedicaid
G67011Medicare UPIN
IN200174200AMedicaid