Healthcare Provider Details

I. General information

NPI: 1326677071
Provider Name (Legal Business Name): CLEMENT JOHN MICHET III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 DOUBLE R BLVD STE 315
RENO NV
89521-6091
US

IV. Provider business mailing address

1155 MILL ST # M-14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-3443
  • Fax: 775-982-3441
Mailing address:
  • Phone: 775-982-3443
  • Fax: 775-982-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29983
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: