Provider Demographics
NPI:1255430807
Name:GREGORY T SHOLEFF MD CH
Entity type:Organization
Organization Name:GREGORY T SHOLEFF MD CH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHOLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-649-2625
Mailing Address - Street 1:1700 N BUFFALO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2677
Mailing Address - Country:US
Mailing Address - Phone:702-649-2625
Mailing Address - Fax:702-233-9786
Practice Address - Street 1:1700 N BUFFALO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2677
Practice Address - Country:US
Practice Address - Phone:702-649-2625
Practice Address - Fax:702-233-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV222707OtherNEVADA HEALTH SOLUTIONS
NVCC8166OtherBCBS
NVCC8166OtherBCBS
NV222707OtherNEVADA HEALTH SOLUTIONS