Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 1230 | NV |
NPI | 1114992203 |
---|---|
Provider Name | Christopher John Gadomski |
First Address | Las Vegas, NV 89114-5645 |
Second Address | Las Vegas, NV 89106-3810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100506759 | (05) | NV |
100506760 | (05) | NV |
I07034 | (02) |