Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 14342 | NV |
Y | 207RC0200X | Critical Care Medicine | 14342 | NV |
NPI | 1073635348 |
---|---|
Provider Name | Dr. Jeremy Mark Gonda |
First Address | Reno, NV 89502-1576 |
Second Address | Reno, NV 89502-1576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073635348 | (05) | NV |
12553643 | CAQH (01) |