Provider Demographics
NPI:1720173602
Name:GRIGORIEV, VICTOR E (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:GRIGORIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:7500 SMOKE RANCH RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0373
Practice Address - Country:US
Practice Address - Phone:702-233-0727
Practice Address - Fax:702-233-4799
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7212208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1720143602Medicaid
NVE80704Medicare UPIN
NV1720143602Medicaid
NVWJBHQ03Medicare ID - Type UnspecifiedMEDICARE #
NVBG2133914OtherDEA REGISTRATION #