Provider Demographics
NPI:1831162262
Name:PISARSKI, GREGORY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:PISARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:504 THIS WAY ST
Mailing Address - Street 2:STE C
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5155
Mailing Address - Country:US
Mailing Address - Phone:979-297-9289
Mailing Address - Fax:979-299-1007
Practice Address - Street 1:215 OAK DR SOUTH
Practice Address - Street 2:STE J
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-9289
Practice Address - Fax:979-299-1007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH92532086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
828314OtherBCBS
5387510OtherAETNA
828314OtherBCBS
G48536Medicare UPIN