Healthcare Provider Details

I. General information

NPI: 1710114616
Provider Name (Legal Business Name): JASON DANIEL KEHRER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 DOUBLE R BLVD
RENO NV
89521-8979
US

IV. Provider business mailing address

5560 KIETZKE LN BLDG A
RENO NV
89511-3019
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-7811
  • Fax: 775-322-1431
Mailing address:
  • Phone: 775-322-7811
  • Fax: 775-322-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11414
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberCL0236
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: