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General NPI Number Information
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NPI Number | 1770017394
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Entity Type | Individual
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Provider Name | ROBERT KENNETH EWING II D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 645 SIERRA ROSE DR. SUITE 103
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City | RENO
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State | NV
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Zip | 89509
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Country | US
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Telephone | 775-322-3011
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Fax | 775-322-1849
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Provider Business Mailing Address
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Address Line | 645 SIERRA ROSE DR STE 103
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City | RENO
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State | NV
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Zip | 89511-4025
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Country | US
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Telephone | 775-322-3011
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Fax | 775-322-1849
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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 | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 449
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License Number State | NV
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