Healthcare Provider Details

I. General information

NPI: 1295873297
Provider Name (Legal Business Name): GREGORY M. ORGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9212 TESORAS DR SUITE 301
LAS VEGAS NV
89144-1569
US

IV. Provider business mailing address

9212 TESORAS DR SUITE 301
LAS VEGAS NV
89144-1569
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberG81845
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number14201
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: