1962455907 NPI number — JERRY MATSUMURA MD, INC. A PROFESSIONAL CORPORATION

Table of content: DR. DAVID JOSEPH LAMBERT DVM (NPI 1760725006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962455907 NPI number — JERRY MATSUMURA MD, INC. A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERRY MATSUMURA MD, INC. A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962455907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18124 WEDGE PKWY STE 232
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89511-8134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-993-9534
Provider Business Mailing Address Fax Number:
775-853-2728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18124 WEDGE PKWY STE 232
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511-8134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-993-9534
Provider Business Practice Location Address Fax Number:
775-853-2728
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATSUMURA
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-993-9534

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  7899 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com