Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 9105 | NV |
NPI | 1215991856 |
---|---|
Provider Name | Dr. Sam R Chacon |
First Address | Reno, NV 89509-3683 |
Second Address | Reno, NV 89509-3683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 05/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002013064 | (05) | NV |