MEDICARE: GREGG CHARLES GEBETSBERGER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	512636	TX

General Provider Information

NPI Number	:	1174564876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGG CHARLES GEBETSBERGER CRNA

Provider Business Mailing Address
First Line	:	1709 DRYDEN RD
Second Line	:	SUITE 1700, MS: BCM120
City	:	HOUSTON
State	:	TX
Zip	:	77030-2400
Country	:	US
Telephone Number	:	713-873-2900
Fax Number	:	713-873-5137

Provider Business Practice Location Address
First Line	:	1709 DRYDEN RD
Second Line	:	SUITE 1700, MS: BCM120
City	:	HOUSTON
State	:	TX
Zip	:	77030-2400
Country	:	US
Telephone Number	:	713-873-2900
Fax Number	:	713-873-5137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/29/2010

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