Provider Demographics
NPI:1285707257
Name:PLETZ, GREGORY (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PLETZ
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:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:250B BUTLER CMNS
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2485
Practice Address - Country:US
Practice Address - Phone:877-987-4368
Practice Address - Fax:724-431-4307
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050717L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014310030011Medicaid
F58231Medicare UPIN
PA0014310030011Medicaid