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NPI Code Detail

MEDICARE: FREMONT PRIMARY CARE LTD

MEDICARE: FREMONT PRIMARY CARE LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207V00000XObstetrics & Gynecology Physician
3363AM0700XMedical Physician Assistant
4363L00000XNurse Practitioner
5207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1093706343
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREMONT PRIMARY CARE LTD
Provider Business Mailing Address
First Line : PO BOX 1737
Second Line :
City : LAS VEGAS
State : NV
Zip : 89125-1737
Country : US
Telephone Number : 702-671-6800
Fax Number : 702-671-6856
Provider Business Practice Location Address
First Line : 520 FREMONT ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-5621
Country : US
Telephone Number : 702-382-5200
Fax Number : 702-477-0047
Authorized Official
Title or Position : CEO
Name : JON GREG GRIFFIN
Credential :
Telephone Number : 702-671-6800
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/13/2007

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Directions to “FREMONT PRIMARY CARE LTD ” Practice Location

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