Provider Demographics
NPI:1801892393
Name:PINEGAR, GREGORY G (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:PINEGAR
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 1:921 OKLAHOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2627
Mailing Address - Country:US
Mailing Address - Phone:580-327-0091
Mailing Address - Fax:580-327-0093
Practice Address - Street 1:921 OKLAHOMA BLVD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2627
Practice Address - Country:US
Practice Address - Phone:580-327-0091
Practice Address - Fax:580-327-0093
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
OK17680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF64287Medicare UPIN