Healthcare Provider Details

I. General information

NPI: 1760641997
Provider Name (Legal Business Name): JONATHAN L MCCALEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 NEIL RD #207
RENO NV
89502-6542
US

IV. Provider business mailing address

5250 NEIL RD #207
RENO NV
89502-6542
US

V. Phone/Fax

Practice location:
  • Phone: 775-398-1981
  • Fax: 775-398-1984
Mailing address:
  • Phone: 775-398-1981
  • Fax: 775-398-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number14163
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: