Provider Demographics
NPI:1881787737
Name:YAGER, GREGORY E (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:YAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W FLAMINGO RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3926
Mailing Address - Country:US
Mailing Address - Phone:702-822-5000
Mailing Address - Fax:702-822-5001
Practice Address - Street 1:4100 W FLAMINGO RD STE 2100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3926
Practice Address - Country:US
Practice Address - Phone:702-822-5000
Practice Address - Fax:702-822-5001
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000228736OtherANTHEM
OHT07454OtherSUMMA
OH2389875Medicaid
OHP00066612OtherRR MEDICARE G YAGER
OH000000228736OtherANTHEM
OH2389875Medicaid