Individual
DR. GREGORY J WASTEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
6850 N DURANGO DR, SUITE 100, LAS VEGAS, NV 89149-4595
(702) 589-3100
(702) 851-7725
Mailing address
PO BOX 12060, LAS VEGAS, NV 89112-0060
(702) 853-7451
(909) 557-1924
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
6905
NV
207N00000X
Dermatology Physician
G59991
CA
207ND0101X
MOHS-Micrographic Surgery Physician
6905
NV
207ND0101X
MOHS-Micrographic Surgery Physician
G59991
CA
207NP0225X
Pediatric Dermatology Physician
6905
NV
207NP0225X
Pediatric Dermatology Physician
G55591
CA
207NS0135X
Procedural Dermatology Physician
6905
NV
207NS0135X
Procedural Dermatology Physician
G59991
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070014199
RAILROAD MEDICARE
NV
05
—
2019476
—
NV
Enumeration date
03/03/2006
Last updated
02/01/2013
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