Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 4894 | NV |
N | 208D00000X | General Practice Physician | 4894 | NV |
NPI | 1548278617 |
---|---|
Provider Name | Dr. Maurice Dubois Gregory JR. |
First Address | Las Vegas, NV 89146-6729 |
Second Address | Las Vegas, NV 89106-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 30/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C96280 | (02) | NV |