Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14579 | NV |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 14579 | NV |
NPI | 1508803362 |
---|---|
Provider Name | Dr. Michael D. Ries |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C500540 | (05) | CA |
10969057 | CAQH (01) | NV |
E66860 | (02) | CA |