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General NPI Number Information
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NPI Number | 1962455907
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Entity Type | Organization
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Legal Business Name | JERRY MATSUMURA MD, INC. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 18124 WEDGE PKWY STE 232
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City | RENO
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State | NV
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Zip | 89511-8134
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Country | US
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Telephone | 801-993-9534
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Fax | 775-853-2728
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Provider Business Mailing Address
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Address Line | 18124 WEDGE PKWY STE 232
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City | RENO
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State | NV
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Zip | 89511-8134
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Country | US
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Telephone | 801-993-9534
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Fax | 775-853-2728
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY S. MATSUMURA
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Credential | MD
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Telephone | 801-993-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 7899
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License Number State | NV
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