Provider Demographics
NPI:1295919538
Name:GREGORY M STIRNEMAN DPM PA
Entity type:Organization
Organization Name:GREGORY M STIRNEMAN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-586-7979
Mailing Address - Street 1:2011 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-5821
Mailing Address - Country:US
Mailing Address - Phone:903-586-7979
Mailing Address - Fax:903-589-0487
Practice Address - Street 1:2011 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5821
Practice Address - Country:US
Practice Address - Phone:903-586-7979
Practice Address - Fax:903-589-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1312213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
=========OtherTAX ID