Individual
DR. GREGORY PAUL WITTPENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3616 N UNIVERSITY DR, NACOGDOCHES, TX 75965-2539
(936) 564-3744
(936) 564-0642
Mailing address
3616 N UNIVERSITY DR, NACOGDOCHES, TX 75965-2539
(936) 564-3744
(936) 564-0642
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
H8896
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
H8896
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070LY
BLUE CROSS PROVIDER #
TX
05
—
173185301
—
TX
01
—
3324976
REDILINK BLUE #
TX
01
—
4470780
AETNA PIN
TX
Enumeration date
03/20/2006
Last updated
04/10/2024
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