Healthcare Provider Details

I. General information

NPI: 1336166370
Provider Name (Legal Business Name): CHARLES BRIAN SONDEREGGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W JOHN ST STE B
CARSON CITY NV
89703-8829
US

IV. Provider business mailing address

412 W JOHN ST STE B
CARSON CITY NV
89703-8829
US

V. Phone/Fax

Practice location:
  • Phone: 775-267-4872
  • Fax: 775-267-1980
Mailing address:
  • Phone: 775-267-4872
  • Fax: 775-267-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3390
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: