Provider Demographics
NPI:1316104946
Name:GREGORY L GOETZ DO A PROFESSIONAL CORP
Entity type:Organization
Organization Name:GREGORY L GOETZ DO A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-320-8111
Mailing Address - Street 1:536 SUMMER MESA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1506
Mailing Address - Country:US
Mailing Address - Phone:702-320-8111
Mailing Address - Fax:702-839-4846
Practice Address - Street 1:7140 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-320-8111
Practice Address - Fax:702-839-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1182207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTAX ID NUMBER