Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 121 | NV |
NPI | 1225440894 |
---|---|
Provider Name | Jerry Reeves |
First Address | Las Vegas, NV 89113-1352 |
Second Address | Las Vegas, NV 89118-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E81417 | (02) | NV |