Healthcare Provider Details

I. General information

NPI: 1639246309
Provider Name (Legal Business Name): FREMONT PRIMARY CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W SUNSET RD SUITE 418
LAS VEGAS NV
89148-4860
US

IV. Provider business mailing address

PO BOX 1737
LAS VEGAS NV
89125-1737
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-3600
  • Fax: 702-939-8827
Mailing address:
  • Phone: 702-671-6800
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: JON GREG GRIFFIN
Title or Position: CEO
Credential: CEO
Phone: 702-671-6800