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General NPI Number Information
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NPI Number | 1639246309
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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 | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9280 W SUNSET RD SUITE 418
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City | LAS VEGAS
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State | NV
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Zip | 89148-4860
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Country | US
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Telephone | 702-430-3600
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Fax | 702-939-8827
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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 | 702-671-6883
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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 | CEO
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NV
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