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DR. GREGORY J WASTEK M.D., PH.D.

Physicians Dermatology

Provider NPI: 1508833930

Provider Information:
DR. GREGORY J WASTEK M.D., PH.D.
Gender: M
Sole Proprietor

Practice Location:
6850 N DURANGO DR SUITE 100 LAS VEGAS, NV 89149-4595 US
Tel: 702-589-3100  Fax: 702-851-7725

Business Mailing Address:
PO BOX 12060  LAS VEGAS, NV 89112-0060 US
Tel: 702-853-7451  Fax: 909-557-1924

NPI Information:
NPI: 1508833930
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207N00000XPhysicians
Dermatology
NV6905
N207N00000XPhysicians
Dermatology
CAG59991
N207ND0101XPhysicians
Dermatology
NV6905
N207ND0101XPhysicians
Dermatology
CAG59991
N207NP0225XPhysicians
Dermatology
NV6905
N207NP0225XPhysicians
Dermatology
CAG55591
N207NS0135XPhysicians
Dermatology
NV6905
N207NS0135XPhysicians
Dermatology
CAG59991

Other Provider Identifiers:

IssuerNumberStateType
RAILROAD MEDICARE070014199NV01
2019476NV05



American Medical Association 2012 taxonomy code information

Code: 207N00000X

Type:

Classification:



Definition:



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