Healthcare Provider Details

I. General information

NPI: 1417273541
Provider Name (Legal Business Name): THE NEVADA CENTER FOR REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SIERRA ROSE DR SUITE 205
RENO NV
89511-2366
US

IV. Provider business mailing address

645 SIERRA ROSE DR SUITE 205
RENO NV
89511-2366
US

V. Phone/Fax

Practice location:
  • Phone: 775-828-1200
  • Fax: 775-828-1785
Mailing address:
  • Phone: 775-828-1200
  • Fax: 775-828-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL A FOULK
Title or Position: MEDICAL DIRECTOR/PARTNER/OWNER
Credential: MD
Phone: 775-828-1200