Provider Demographics
NPI:1174867410
Name:SMAGH, GURPREET SINGH (PAC)
Entity Type:Individual
Prefix:
First Name:GURPREET
Middle Name:SINGH
Last Name:SMAGH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 N TENAYA WAY
Mailing Address - Street 2:NV017-0328
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0424
Mailing Address - Country:US
Mailing Address - Phone:702-240-8934
Mailing Address - Fax:855-307-3599
Practice Address - Street 1:2716 N TENAYA WAY
Practice Address - Street 2:NV017-0328
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-240-8934
Practice Address - Fax:855-307-3599
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22292363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical