Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 1000045-521 | NV |
NPI | 1073645099 |
---|---|
Provider Name | Steven John Gorbet |
First Address | Las Vegas, NV 89145-4561 |
Second Address | Las Vegas, NV 89102-8317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000045-521 | MASSAGE ESTABLISHMENT (01) | NV |