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General NPI Number Information
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NPI Number | 1548339310
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Entity Type | Organization
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Legal Business Name | GREG A. NESTEBY
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 4433 34TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-2416
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Country | US
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Telephone | 806-792-6193
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Fax | 806-792-2863
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Provider Business Mailing Address
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Address Line | 4433 34TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-2416
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Country | US
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Telephone | 806-792-6193
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Fax | 806-792-2863
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY ALFRED NESTEBY
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Credential | L.O., B.O.C., A.B.C.
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Telephone | 806-792-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 222Z00000X ORTHO 377
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License Number State | TX
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