Healthcare Provider Details

I. General information

NPI: 1366569311
Provider Name (Legal Business Name): EMILE G VANDERMEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 RYLAND ST SUITE 100
RENO NV
89502-1667
US

IV. Provider business mailing address

780 KUENZLI ST SUITE 202
RENO NV
89502-0845
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-3900
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number6858
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: