Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 5729 | NV |
Y | 208600000X | Surgeon | 5729 | NV |
NPI | 1003804063 |
---|---|
Provider Name | John Lloyd Haller |
First Address | Reno, NV 89502-1181 |
Second Address | Reno, NV 89502-1181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CC4369 | BCBS (01) | |
D43151 | (02) | |
XPY187232 | (05) | CA |