Healthcare Provider Details

I. General information

NPI: 1821317728
Provider Name (Legal Business Name): JACOB P ZUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST SIERRA TOWER, 5TH FLOOR
RENO NV
89502
US

IV. Provider business mailing address

850 HARVARD WAY
RENO NV
89502-2055
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5123
  • Fax: 775-982-5470
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number16549
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number16549
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: