Basic Information
| Provider Information | |||||||||
| NPI: | 1740554336 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGORY NORMAN MESSNER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 W 15TH ST | ||||||||
| Address2: | SUITE 480 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725198300 | ||||||||
| FaxNumber: | 9725198337 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 W 15TH ST | ||||||||
| Address2: | SUITE 480 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725198300 | ||||||||
| FaxNumber: | 9725198337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MESSNER | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | NORMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2143643050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
| NPICertificationDate: | 04/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | GDC26 | 05 | TX | MEDICAID | 149924614 | 05 | TX | MEDICAID |