Provider Demographics
NPI:1215565262
Name:STANGER, GREGORY-THOMAS
Entity Type:Individual
Prefix:
First Name:GREGORY-THOMAS
Middle Name:
Last Name:STANGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4218
Mailing Address - Country:US
Mailing Address - Phone:352-333-5982
Mailing Address - Fax:
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2352
Practice Address - Country:US
Practice Address - Phone:702-671-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program