Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 14611 | NV |
NPI | 1255596722 |
---|---|
Provider Name | Jeffery Johnson Muir |
First Address | Reno, NV 89503-4538 |
Second Address | Reno, NV 89503-4538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 02/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |
P00970250 | RAILROAD MEDICARE (01) | MN |