Canyon Gate Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

12804 Issued in NV

Legal business name

CANYON GATE MEDICAL GROUP, LLC

Practice address

9280 W Sunset Rd
Suite 426
Las Vegas, NV 89148-4860

Phone

(702) 262-0124

Fax

(702) 262-0143

NPI assigned

Sep 18, 2008

Last updated

Apr 20, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ricki Moskow

Title

President

Phone

(954) 656-8855

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240185600000",
    "number": "1396994943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 N UNIVERSITY DR",
            "address_2": "SUITE 110",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655081",
            "telephone_number": "954-656-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9280 W SUNSET RD",
            "address_2": "SUITE 426",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484860",
            "telephone_number": "702-262-0124",
            "fax_number": "702-262-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON GATE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-18",
        "last_updated": "2009-04-20",
        "status": "A",
        "authorized_official_last_name": "MOSKOW",
        "authorized_official_first_name": "RICKI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-656-8855"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "12804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396994943",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.