Provider Demographics
NPI:1659406304
Name:GOETZ, GREGORY LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:GOETZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:645 E MISSOURI AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8917
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:9260 W SUNSET RD
Practice Address - Street 2:STE. 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4858
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-921-2419
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-03-25
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Provider Licenses
StateLicense IDTaxonomies
NV1182207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504861Medicaid
I26781Medicare UPIN
NV100413Medicare ID - Type UnspecifiedPROVIDER NUMBER