Provider Demographics
NPI:1760604896
Name:GREGORY S VUKSINICH, M.D., INC
Entity Type:Organization
Organization Name:GREGORY S VUKSINICH, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VUKSINICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-747-5050
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:223 CLINTON RD
Practice Address - Street 2:STE 204
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2680
Practice Address - Country:US
Practice Address - Phone:775-747-5050
Practice Address - Fax:775-747-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41691207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C416910Medicare ID - Type Unspecified