MEDICARE: GREGORY M. ORGAN MD

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	2086S0120X	Pediatric Surgery Physician	G81845	CA
2	2086S0120X	Pediatric Surgery Physician	14201	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295873297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY M. ORGAN MD

Provider Business Mailing Address
First Line	:	9212 TESORAS DR
Second Line	:	SUITE 301
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9212 TESORAS DR
Second Line	:	SUITE 301
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1569
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/09/2012

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