Provider Demographics
NPI:1700966090
Name:PIPPIN, GREGORY WALKER (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WALKER
Last Name:PIPPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:PIPPIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-887-3223
Mailing Address - Fax:504-889-5438
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-887-3223
Practice Address - Fax:504-889-5438
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14971R207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH62067Medicare UPIN