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NPI Code Detail

MEDICARE: FREMONT PRIMARY CARE - ENDOCRINOLOGY

MEDICARE: FREMONT PRIMARY CARE - ENDOCRINOLOGY
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
1133V00000XRegistered Dietitian
2207RE0101XEndocrinology, Diabetes & Metabolism Physician
3363L00000XNurse Practitioner
4133VN1006XMetabolic Nutrition Registered Dietitian

General Provider Information

NPI Number : 1295712693
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREMONT PRIMARY CARE - ENDOCRINOLOGY
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 : 702-671-6855
Provider Business Practice Location Address
First Line : 4880 WYNN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5406
Country : US
Telephone Number : 702-362-3422
Fax Number : 702-939-8827
Authorized Official
Title or Position : CEO
Name : JON GREG GRIFFIN
Credential :
Telephone Number : 702-671-6800
Provider Enumeration Date : 12/27/2005
Last Update Date : 09/11/2025

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