GARY T DIRISIO (NPI# 1558873828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558873828 |
| Entity Type | Individual |
| Full Name | GARY T DIRISIO |
| Credential | PHARM D |
| Practice Address |
4700 Las Vegas Blvd N Nellis Afb NV 89191-6600 |
| Practice Telephone | 7026533578 |
| Mailing Telephone | 7026533578 |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2020-09-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208U00000X | Clinical Pharmacology | 09138 | NV | Allopathic & Osteopathic Physicians |
| Y | 208U00000X | Clinical Pharmacology | 39645 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
4700 LAS VEGAS BLVD N |
| City | NELLIS AFB |
| State | NV |
| Zip Code | 89191-6600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366445389 | Frank J Andriola | Internal Medicine | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2005-05-23 |
| 1245837392 | Cameron Springer | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-10-01 |
| 1063026474 | Haley Suzanne Emery | Physician Assistant | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-09-02 |
| 1033729991 | Brock Shaw | Dentist | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-08-05 |
| 1801404397 | Madelyn Danielle Golden | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-07-21 |
| 1114544103 | Jami Myong Reece | Family Medicine | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-06-25 |
| 1225654296 | Leah Corr | Physician Assistant | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-06-24 |
| 1821614405 | Aubrey Amanda Blanchette | Student in an Organized Health Care Education/Training Program | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-06-19 |
| 1346866290 | Shelbi Diane Duncan | Physician Assistant | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-06-17 |
| 1235751538 | Howard Luong | Physician Assistant | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225662687 | Ashley Raye Roth-garcia | Student in an Organized Health Care Education/Training Program | 99th Medical Group 4700 Las Vegas Blvd North, Nellis Afb, NV 89191 | 2020-02-25 |
| 1427553734 | Christopher Robert Weisgarber | Student in an Organized Health Care Education/Training Program | Mike O'callaghan Military Medical Center, 4700 Las Vegas Blvd North Bldg 1300, Las Vegas, NV 89191 | 2018-03-28 |
| 1912345448 | Austin Joseph Ladner | Dentist | 99th Air Base Wing Public Affairs, Fpo, AA 89191 | 2013-06-06 |
| 1528329018 | Mayer M Jeppson | Psychologist | 4700 Las Vegas Blvd. N, Nellis Afb, NV 89191 | 2012-05-31 |
| 1255560462 | Jordan Lawrence | Military Health Care Provider | 1579 Malmstrom Avenue, Nellis Afb, NV 89191 | 2009-07-09 |
| 1225263072 | Adrienne L Clark | Military Health Care Provider | 5154 Ellsworth Ave, Suite 61690, Las Vegas, NV 89191 | 2009-05-22 |
| 1568634335 | Eleanor C Basilio | Registered Nurse | 4700 Las Vegas Blvd., Nellis Afb, NV 89191 | 2008-04-01 |
| 1316137037 | Sarah Rachel Glick | Pediatrics | 4700 N. Las Vegas Blvd., Mike O'callaghan Federal Medical Center, 99 Mdos/sgoc, Nellis Afb, NV 89191 | 2007-07-30 |
| 1619181302 | Ben Carter Robinson | Orthopaedic Surgery | 4700 N. Las Vegas Blvd, Nellis Afb-mofh Nellis Orthopedics, Las Vegas, NV 89191 | 2007-05-10 |
| 1609992205 | Conrad Lochner IIi, Odpc | Optometrist | 5691 Rickenbacker Road, Bldg. 431, Las Vegas, NV 89191 | 2007-03-22 |
| Find all providers in zip 89191 | ||||
| Taxonomy Code | 208U00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Clinical Pharmacology |
| Clinical pharmacology encompasses the spectrum of activities related to the discovery, development, regulation, and utilization of safe and effective drugs. |
| Notes: Source: American Society for Clinical Pharmacology and Therapeutics, 2008 [7/1/2008: modified definition] Additional Resources: Clinical pharmacology is a recognized fellowship program for physicians, pharmacists, and post-doctoral researchers delivered through medical education institutions accredited by the American Board of Clinical Pharmacology. http://www.ascpt.org/; American Board of Clinical Pharmacology http://www.abcp.net/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073012076 | Rajesh Chandra Shrotriya | Clinical Pharmacology | 5 Highland Creek Dr, Henderson, NV 89052-6612 | 2018-02-05 |
| 1588151344 | Jason Dent | Clinical Pharmacology | 1155 Mill St, Reno, NV 89502-1576 | 2018-04-17 |
| City | NELLIS AFB |
| Zip Code | 89191 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.