Provider Demographics
NPI:1144281296
Name:SCHWARTZ, GREGORY G (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:G
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0127
Mailing Address - Country:US
Mailing Address - Phone:817-341-0993
Mailing Address - Fax:817-596-5109
Practice Address - Street 1:750 EUREKA ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6521
Practice Address - Country:US
Practice Address - Phone:817-324-0993
Practice Address - Fax:817-596-5109
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1662207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200034001Medicaid
TX0012AVOtherBCBS
TX096342304Medicaid
200034001OtherRAILROAD MEDICARE
TX096342303Medicaid
200034001OtherRAILROAD MEDICARE
TX0012AVOtherBCBS
TX096342303Medicaid
TX8F1243Medicare PIN