Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 14201 | NV |
N | 2086S0120X | Pediatric Surgery | G81845 | CA |
NPI | 1295873297 |
---|---|
Provider Name | Gregory M. Organ |
First Address | Las Vegas, NV 89144-1569 |
Second Address | Las Vegas, NV 89144-1569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 09/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G818450 | (05) | CA |
F39244 | (02) |