Provider Demographics
NPI:1912182890
Name:PEDIATRIC GASTROENTEROLOGY PROF ASSN
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY PROF ASSN
Other - Org Name:PEDIATRIC GAST AND NUTRI ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-791-0477
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2314
Mailing Address - Country:US
Mailing Address - Phone:702-791-0477
Mailing Address - Fax:702-791-6831
Practice Address - Street 1:3196 S MARYLAND PKWY STE 309
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2314
Practice Address - Country:US
Practice Address - Phone:702-791-0477
Practice Address - Fax:702-791-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV67392080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF11181Medicare UPIN
NVI07260Medicare UPIN
NVF75446Medicare UPIN