=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518106145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W R TRIMMER MD LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 03/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 343 ELM ST STE 204
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-348-8555
-----------------------------------------------------
Fax | 775-348-6479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 343 ELM ST STE 204
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-348-8555
-----------------------------------------------------
Fax | 775-348-6479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOOKKEEPER
-----------------------------------------------------
Name | JAN STIMMEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-348-8555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4778
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------