Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 19932 | NV |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 19932 | NV |
NPI | 1053739003 |
---|---|
Provider Name | Vadim Goz |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2014 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053739003 | (05) | NV |
14473403 | CAQH (01) |