Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 6437 | NV |
Y | 1223G0001X | General Practice | 6437 | NV |
Y | 213EG0000X | General Practice | 6437 | NV |
NPI | 1134560519 |
---|---|
Provider Name | Dr. John Eric Cercek |
First Address | Reno, NV 89509-3636 |
Second Address | Reno, NV 89509-3636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2013 |
Last Update Date | 20/04/2015 |