Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 3204 | NV |
N | 207PE0004X | Emergency Medical Services | 3204 | NV |
NPI | 1124087390 |
---|---|
Provider Name | Gary G. Gansert |
First Address | Reno, NV 89510-1276 |
Second Address | Reno, NV 89502-1576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 05/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201660007 | (05) | NV |
930104798 | RAILROAD MEDICARE (01) | NV |
CC3680 | BC/BS (01) | NV |
E44157 | (02) | NV |