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General NPI Number Information
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NPI Number | 1093706343
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Entity Type | Organization
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Legal Business Name | FREMONT PRIMARY CARE LTD
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 520 FREMONT ST
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City | LAS VEGAS
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State | NV
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Zip | 89101-5621
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Country | US
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Telephone | 702-382-5200
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Fax | 702-477-0047
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Provider Business Mailing Address
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Address Line | PO BOX 1737
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City | LAS VEGAS
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State | NV
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Zip | 89125-1737
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Country | US
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Telephone | 702-671-6800
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Fax | 702-671-6856
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Authorized Official
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Title or Position | CEO
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Name | JON GREG GRIFFIN
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Credential |
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Telephone | 702-671-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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