Provider Demographics
NPI:1295760833
Name:GREG G. SCHWARTZ, M.D., P.A.
Entity type:Organization
Organization Name:GREG G. SCHWARTZ, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-341-0993
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0127
Mailing Address - Country:US
Mailing Address - Phone:817-341-0993
Mailing Address - Fax:817-596-5109
Practice Address - Street 1:1424 CLEAR LAKE RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5806
Practice Address - Country:US
Practice Address - Phone:817-341-0993
Practice Address - Fax:817-596-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1662207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DS0816OtherRAILROAD MEDICARE
TX209090401Medicaid
TX209411201Medicaid
TX209090401Medicaid
TXG29879Medicare UPIN
TX00566ZMedicare PIN