Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9686 | NV |
N | 207QS0010X | Family Doctor - Sports Medicine | 9686 | NV |
NPI | 1053384107 |
---|---|
Provider Name | Robert Tucker Thole |
First Address | Reno, NV 89502-2055 |
Second Address | Reno, NV 89502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 06/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016818 | (05) | NV |
080173706 | RAILROAD MEDICARE (01) | NV |
11042017 | CAQH (01) | |
H40862 | (02) | NV |
P00259419 | RR MEDICARE (01) | NV |