Healthcare Provider Details

I. General information

NPI: 1083785174
Provider Name (Legal Business Name): EVAN MITCHELL KLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 N VIRGINIA ST MS / 153
RENO NV
89557-0001
US

IV. Provider business mailing address

401 W 2ND ST 235D
RENO NV
89503-5345
US

V. Phone/Fax

Practice location:
  • Phone: 775-784-4474
  • Fax: 775-784-4468
Mailing address:
  • Phone: 775-682-8175
  • Fax: 775-327-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number131486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number12641
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: