Healthcare Provider Details

I. General information

NPI: 1801877790
Provider Name (Legal Business Name): GREGORY BERNARD HOVERSTEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 VIA VASARI
HENDERSON NV
89011-3661
US

IV. Provider business mailing address

22 VIA VASARI
HENDERSON NV
89011-3661
US

V. Phone/Fax

Practice location:
  • Phone: 712-251-0542
  • Fax:
Mailing address:
  • Phone: 712-251-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO1811
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: