Healthcare Provider Details

I. General information

NPI: 1174564876
Provider Name (Legal Business Name): GREGG CHARLES GEBETSBERGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 DRYDEN RD SUITE 1700, MS: BCM120
HOUSTON TX
77030-2400
US

IV. Provider business mailing address

1709 DRYDEN RD SUITE 1700, MS: BCM120
HOUSTON TX
77030-2400
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-2900
  • Fax: 713-873-5137
Mailing address:
  • Phone: 713-873-2900
  • Fax: 713-873-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number512636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: