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General NPI Number Information
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NPI Number | 1134864564
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Entity Type | Individual
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Provider Name | JASON ALEXANDER LUNDY DO
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Gender | Male
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 1155 MILL ST
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 745 W MOANA LN STE 300
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City | RENO
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State | NV
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Zip | 89509-4980
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Country | US
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Telephone | 775-432-6577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 58.032971
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | SL1993
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License Number State | NV
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