Healthcare Provider Details

I. General information

NPI: 1821592684
Provider Name (Legal Business Name): JIRI FRANCIS KUBAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST # MS M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-4196
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21157
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: