Provider Demographics
NPI:1831255298
Name:REMIEN, GREGORY S (PAC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:REMIEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3473
Mailing Address - Country:US
Mailing Address - Phone:979-776-0169
Mailing Address - Fax:979-776-1372
Practice Address - Street 1:3121 UNIVERSITY DR E STE 100
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-0169
Practice Address - Fax:979-776-1372
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004798363AM0700X, 363AS0400X
TXPA11207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374100101Medicaid
WA8417420Medicaid
WAG8851478Medicare PIN
WAG8851479Medicare PIN
WAG8872513Medicare PIN
WAG8851481Medicare PIN
WAG8851480Medicare PIN
WAG8851482Medicare PIN