Healthcare Provider Details

I. General information

NPI: 1184620742
Provider Name (Legal Business Name): GREGORY SHOOU-REN HSU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 N PECOS RD
HENDERSON NV
89074-1918
US

IV. Provider business mailing address

299 N PECOS RD
HENDERSON NV
89074-1918
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-6000
  • Fax:
Mailing address:
  • Phone: 702-450-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDO702
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: