Provider Demographics
NPI:1538169966
Name:ANIGIAN, GREGG MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:MICHAEL
Last Name:ANIGIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-369-0006
Mailing Address - Fax:214-369-0190
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-369-0006
Practice Address - Fax:214-369-0190
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH71162086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC71223Medicare UPIN
TX00G36MMedicare PIN
TXTXB111186Medicare PIN