Healthcare Provider Details

I. General information

NPI: 1922195700
Provider Name (Legal Business Name): JEFFERY D HANRAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 505
RENO NV
89502-1469
US

IV. Provider business mailing address

1155 MILL ST # MSM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-4673
  • Fax: 806-212-0057
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number23414
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberR1767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: