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General NPI Number Information
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NPI Number | 1508833930
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Entity Type | Individual
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Provider Name | GREGORY J WASTEK M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 6850 N DURANGO DR SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89149-4595
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Country | US
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Telephone | 702-589-3100
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Fax | 702-851-7725
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Provider Business Mailing Address
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Address Line | PO BOX 12060
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City | LAS VEGAS
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State | NV
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Zip | 89112-0060
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Country | US
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Telephone | 702-853-7451
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Fax | 909-557-1924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 6905
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G59991
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 6905
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | G59991
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 6905
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License Number State | NV
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Taxonomy #6
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | G55591
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 6905
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License Number State | NV
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Taxonomy #8
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | G59991
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License Number State | CA
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